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NPI Code Detail

MEDICARE: MS. ELLEN PENNELL HAGEDORN CNM

MEDICARE: MS. ELLEN PENNELL HAGEDORN CNM
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
1367A00000XAdvanced Practice MidwifeNMW 1711CA

General Provider Information

NPI Number : 1821107798
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ELLEN PENNELL HAGEDORN CNM
Provider Business Mailing Address
First Line : 2185 PACHECO ST
Second Line :
City : CONCORD
State : CA
Zip : 94520-2309
Country : US
Telephone Number : 925-676-0505
Fax Number : 866-886-7824
Provider Business Practice Location Address
First Line : 2185 PACHECO ST
Second Line :
City : CONCORD
State : CA
Zip : 94520-2309
Country : US
Telephone Number : 925-676-0505
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 06/08/2016

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