Healthcare Provider Details

I. General information

NPI: 1447327077
Provider Name (Legal Business Name): SUE ELLEN HAGER F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 OLDS ST
JONESVILLE MI
49250-1128
US

IV. Provider business mailing address

2670 W PARNALL RD
JACKSON MI
49201-9036
US

V. Phone/Fax

Practice location:
  • Phone: 517-849-7100
  • Fax:
Mailing address:
  • Phone: 571-784-1575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704106139
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: