MEDICARE: PAMELA JOANNE HAGWOOD MSN

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	363L00000X	Nurse Practitioner	RN162016	OH
2	363LF0000X	Family Nurse Practitioner	COA 00971 NP	OH

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	:	1568558534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA JOANNE HAGWOOD MSN

Provider Business Mailing Address
First Line	:	2912 SPRINGBORO W
Second Line	:	SUITE 201
City	:	MORAINE
State	:	OH
Zip	:	45439-1674
Country	:	US
Telephone Number	:	937-439-7411
Fax Number	:	937-433-8030

Provider Business Practice Location Address
First Line	:	2912 SPRINGBORO W
Second Line	:	SUITE 201
City	:	MORAINE
State	:	OH
Zip	:	45439-1674
Country	:	US
Telephone Number	:	937-439-7411
Fax Number	:	937-439-8030

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	09/30/2013

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