Healthcare Provider Details

I. General information

NPI: 1316830144
Provider Name (Legal Business Name): REBECCA ANN HAGAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA ANN DAUGHETY RN

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10211 ALM ST STE 1200
RALEIGH NC
27617-8221
US

IV. Provider business mailing address

1002 PLANTERS TRAIL CT
KNIGHTDALE NC
27545-8893
US

V. Phone/Fax

Practice location:
  • Phone: 919-206-4889
  • Fax:
Mailing address:
  • Phone: 252-864-9775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number294975
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: