Basic Information
| Provider Information | |||||||||
| NPI: | 1245954684 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAGY | ||||||||
| FirstName: | SIERRA | ||||||||
| MiddleName: | SANDIA | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 64 COTTAGEVIEW LN | ||||||||
| Address2: | |||||||||
| City: | ELK GARDEN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 267174400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047902501 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 HOSPITAL DR STE 3 | ||||||||
| Address2: | |||||||||
| City: | PETERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 268479570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042571015 | ||||||||
| FaxNumber: | 3042571129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2022 | ||||||||
| LastUpdateDate: | 09/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 107164 | WV | Y | Nursing Service Providers | Registered Nurse |
No ID Information.