MEDICARE: NOLAN HAGEN FNP-C

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	4704363994NSA2507C	MI

General Provider Information

NPI Number	:	1962298588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOLAN HAGEN FNP-C

Provider Business Mailing Address
First Line	:	10577 W TOWNSEND RD
Second Line	:
City	:	FOWLER
State	:	MI
Zip	:	48835-9112
Country	:	US
Telephone Number	:	517-526-5296
Fax Number	:

Provider Business Practice Location Address
First Line	:	935 CHARLEVOIX DR STE 200
Second Line	:
City	:	GRAND LEDGE
State	:	MI
Zip	:	48837-2293
Country	:	US
Telephone Number	:	517-913-4043
Fax Number	:

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

Provider Enumeration Date	:	04/18/2025
Last Update Date	:	11/26/2025

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