Healthcare Provider Details

I. General information

NPI: 1801907647
Provider Name (Legal Business Name): BRENDA W HAGAN RNC, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 HOSPITAL DR
FREDERICKSBURG VA
22401-8424
US

IV. Provider business mailing address

PO BOX 1460
FREDERICKSBURG VA
22402-1460
US

V. Phone/Fax

Practice location:
  • Phone: 540-899-5864
  • Fax: 540-372-2023
Mailing address:
  • Phone: 540-786-2100
  • Fax: 540-786-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0017001521
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: