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NPI Code Detail

MEDICARE: DR. ALICE HANNAH ROSE FAGEN MD

MEDICARE: DR. ALICE HANNAH ROSE FAGEN MD
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1679269310
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALICE HANNAH ROSE FAGEN MD
Provider Business Mailing Address
First Line : 2020 E 28TH ST STE 104
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1925
Country : US
Telephone Number : 612-333-0770
Fax Number :
Provider Business Practice Location Address
First Line : 2020 E 28TH ST STE 104
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1925
Country : US
Telephone Number : 612-333-0770
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2023
Last Update Date : 04/14/2023

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