Healthcare Provider Details

I. General information

NPI: 1326463662
Provider Name (Legal Business Name): STACIE HOAGLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 N 2ND ST
PIEDMONT MO
63957-1301
US

IV. Provider business mailing address

306 N 2ND ST
PIEDMONT MO
63957-1301
US

V. Phone/Fax

Practice location:
  • Phone: 573-223-4169
  • Fax:
Mailing address:
  • Phone: 573-223-4169
  • Fax: 573-223-7691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: