Basic Information
| Provider Information | |||||||||
| NPI: | 1174637060 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HATFIELD | ||||||||
| FirstName: | AGNIESZKA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11850 BLACKFOOT ST NW STE 130 | ||||||||
| Address2: | |||||||||
| City: | COON RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554332583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632361900 | ||||||||
| FaxNumber: | 7632369010 | ||||||||
| Practice Location | |||||||||
| Address1: | 11850 BLACKFOOT ST NW STE 130 | ||||||||
| Address2: | |||||||||
| City: | COON RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554332583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632361900 | ||||||||
| FaxNumber: | 7632369010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 11/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | K2093 | TX | N | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | 2086S0122X | 44333 | MN | Y | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 180700500 | 05 | MN | MEDICAID | 7581471 | 01 | AETNA | OTHER | 180700500 | 01 | MN | MA | OTHER | 1300140 | 01 | MN | MEDICA | OTHER | 131146 | 01 | MN | UCARE | OTHER | 131MOHA | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | C03935 | 01 | MA | MEDICARE CORPORATION | OTHER | 92321 | 01 | MN | HEALTH PARTNERS | OTHER |