MEDICARE: MARIE A HAGER APRN FNP

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	CNP141122	ME
2	363LF0000X	Family Nurse Practitioner	053982-23	NH

General Provider Information

NPI Number	:	1881075802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE A HAGER APRN FNP

Provider Business Mailing Address
First Line	:	PO BOX 446
Second Line	:
City	:	CENTER CONWAY
State	:	NH
Zip	:	03813-0446
Country	:	US
Telephone Number	:	207-632-9881
Fax Number	:	603-447-5148

Provider Business Practice Location Address
First Line	:	47 WASHINGTON ST
Second Line	:
City	:	CONWAY
State	:	NH
Zip	:	03818-6057
Country	:	US
Telephone Number	:	603-662-4680
Fax Number	:	855-609-1958

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

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	08/01/2019

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