Healthcare Provider Details

I. General information

NPI: 1801718465
Provider Name (Legal Business Name): MRS. CYDNI JANELLE HAGSTROM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3629 S D ST
TACOMA WA
98418-6813
US

IV. Provider business mailing address

8203 59TH AVE E
PUYALLUP WA
98371-8316
US

V. Phone/Fax

Practice location:
  • Phone: 253-649-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberPC61580252
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: