MEDICARE: LAURA HAGEMAN

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	1223D0001X	Public Health Dentistry	13114804022	KS
2	163WA2000X	Administrator Registered Nurse	13114804022	KS

General Provider Information

NPI Number	:	1467797142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA HAGEMAN

Provider Business Mailing Address
First Line	:	119 S MAIN ST
Second Line	:
City	:	SMITH CENTER
State	:	KS
Zip	:	66967-2605
Country	:	US
Telephone Number	:	785-282-6656
Fax Number	:	785-282-3301

Provider Business Practice Location Address
First Line	:	119 S MAIN ST
Second Line	:
City	:	SMITH CENTER
State	:	KS
Zip	:	66967-2605
Country	:	US
Telephone Number	:	785-282-6656
Fax Number	:	785-282-3301

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

Provider Enumeration Date	:	12/06/2012
Last Update Date	:	06/11/2015

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Directions to “ LAURA HAGEMAN ” Practice Location

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