MEDICARE: MS. JACQUELINE M. HAGELBERG F.N.P

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F331417-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285621904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACQUELINE M. HAGELBERG F.N.P

Provider Business Mailing Address
First Line	:	33 SUMMIT OAKS
Second Line	:
City	:	PITTSFORD
State	:	NY
Zip	:	14534-3261
Country	:	US
Telephone Number	:	585-385-5788
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 LAC DEVILLE BLVD.
Second Line	:	GREATER ROCHESTER NEUROLOGY
City	:	ROCHESTER
State	:	NY
Zip	:	14618
Country	:	US
Telephone Number	:	585-546-3265
Fax Number	:	585-232-5158

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	11/24/2009

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