Healthcare Provider Details

I. General information

NPI: 1598194250
Provider Name (Legal Business Name): KRISTY HAGEN RN MSN CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 COON RAPIDS BLVD NW
COON RAPIDS MN
55433-2522
US

IV. Provider business mailing address

4050 COON RAPIDS BLVD NW
COON RAPIDS MN
55433-2522
US

V. Phone/Fax

Practice location:
  • Phone: 763-236-7137
  • Fax:
Mailing address:
  • Phone: 763-236-7137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberR-120901-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: