Healthcare Provider Details

I. General information

NPI: 1669680393
Provider Name (Legal Business Name): CONNIE HAGAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 KELLY BLVD
SLIPPERY ROCK PA
16057-1155
US

IV. Provider business mailing address

606 W MERCER STREET EXT
HARRISVILLE PA
16038-1514
US

V. Phone/Fax

Practice location:
  • Phone: 724-794-4023
  • Fax: 724-794-3675
Mailing address:
  • Phone: 724-735-4415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN199361L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: