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General NPI Number Information
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NPI Number | 1962298588
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Entity Type | Individual
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Provider Name | NOLAN HAGEN FNP-C
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Gender | Male
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Dates
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Enumeration Date | 04/18/2025
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 935 CHARLEVOIX DR STE 200
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City | GRAND LEDGE
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State | MI
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Zip | 48837-2293
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Country | US
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Telephone | 517-913-4043
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Fax |
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Provider Business Mailing Address
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Address Line | 10577 W TOWNSEND RD
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City | FOWLER
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State | MI
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Zip | 48835-9112
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Country | US
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Telephone | 517-526-5296
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704363994NSA2507C
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License Number State | MI
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