Basic Information
| Provider Information | |||||||||
| NPI: | 1811442957 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAGEN | ||||||||
| FirstName: | TRACI | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 ROSARY DR | ||||||||
| Address2: | ATTN: LISA SMITH | ||||||||
| City: | CORNING | ||||||||
| State: | IA | ||||||||
| PostalCode: | 508411683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6413225425 | ||||||||
| FaxNumber: | 6413224687 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 ROSARY DR | ||||||||
| Address2: | |||||||||
| City: | CORNING | ||||||||
| State: | IA | ||||||||
| PostalCode: | 508411683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6413225245 | ||||||||
| FaxNumber: | 6413224687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2016 | ||||||||
| LastUpdateDate: | 08/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A107752 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.