Healthcare Provider Details

I. General information

NPI: 1346058013
Provider Name (Legal Business Name): JULIA HAGEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 12/26/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 53RD AVE
BETTENDORF IA
52722-6279
US

IV. Provider business mailing address

22709 57TH AVE N
PORT BYRON IL
61275-9705
US

V. Phone/Fax

Practice location:
  • Phone: 563-421-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA182576
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: