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General NPI Number Information
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NPI Number | 1912972829
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Entity Type | Individual
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Provider Name | ROBERT MANN HAGAN CRNA
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Gender | Male
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 2201 LEXINGTON AVE
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City | ASHLAND
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State | KY
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Zip | 41101
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Country | US
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Telephone | 606-327-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 3785 RELIABLE PKWY
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City | CHICAGO
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State | IL
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Zip | 60686-0037
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Country | US
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Telephone | 316-281-3700
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Fax | 316-282-4322
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 1099A
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License Number State | KY
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