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General NPI Number Information
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NPI Number | 1699453886
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Entity Type | Individual
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Provider Name | NATALIE ANN HAGAN AGACNP
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Gender | Female
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Dates
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Enumeration Date | 07/07/2023
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 11951 MOUNT VERNON AVE
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City | GRAND TERRACE
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State | CA
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Zip | 92313-5171
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Country | US
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Telephone | 951-204-8111
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Fax |
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Provider Business Mailing Address
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Address Line | 11951 MOUNT VERNON AVE
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City | GRAND TERRACE
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State | CA
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Zip | 92313-5171
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Country | US
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Telephone | 951-204-8111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | 95025553
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 95025553
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 95025553
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License Number State | CA
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