Healthcare Provider Details

I. General information

NPI: 1952882748
Provider Name (Legal Business Name): TONYA L HAGER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 32ND ST SW
FARGO ND
58103-3428
US

IV. Provider business mailing address

1620 36 1/2 AVE S
FARGO ND
58104-6102
US

V. Phone/Fax

Practice location:
  • Phone: 866-284-8788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR35504
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: