Healthcare Provider Details

I. General information

NPI: 1932199510
Provider Name (Legal Business Name): NANCY M HAGBERG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 OAK AVE
WORCESTER MA
01605-2752
US

IV. Provider business mailing address

340 MAIN STREET SUITE 670
WORCESTER MA
01608-1681
US

V. Phone/Fax

Practice location:
  • Phone: 508-757-7300
  • Fax: 508-757-7900
Mailing address:
  • Phone: 508-754-3566
  • Fax: 508-438-6368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number156558
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN156558
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: