Basic Information
| Provider Information | |||||||||
| NPI: | 1740771591 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAGA | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 19485 OLD JETTON RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | CORNELIUS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280316583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043165170 | ||||||||
| FaxNumber: | 7043165172 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2018 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 2020-04645 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.