Healthcare Provider Details

I. General information

NPI: 1871269969
Provider Name (Legal Business Name): CHARLOTTE HAGARTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7015 LIGHTHOUSE WAY STE 300
PERRYSBURG OH
43551-7018
US

IV. Provider business mailing address

15 PARKVIEW DR
PERRYSBURG OH
43551-3112
US

V. Phone/Fax

Practice location:
  • Phone: 419-520-7546
  • Fax:
Mailing address:
  • Phone: 419-575-5749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0029527
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.411718
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: