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General NPI Number Information
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NPI Number | 1881466092
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Entity Type | Individual
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Provider Name | MONICA HAGEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/23/2023
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 1200 E TINKHAM AVE
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City | LUDINGTON
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State | MI
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Zip | 49431-2740
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Country | US
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Telephone | 231-480-1116
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 E TINKHAM AVE
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City | LUDINGTON
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State | MI
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Zip | 49431-2740
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Country | US
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Telephone | 231-480-1116
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601011953
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License Number State | MI
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