1801874839 NPI number — EMILIE A HAGAN ARNP, CDE

Table of content: MRS. DAWN LAVELLE SHARE A.P. (NPI 1477887784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801874839 NPI number — EMILIE A HAGAN ARNP, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAGAN
Provider First Name:
EMILIE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801874839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7329 N WOODLAWN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEY CENTER
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67147-8560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-219-3571
Provider Business Mailing Address Fax Number:
316-219-3573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1431 BLUFFVIEW ST
Provider Second Line Business Practice Location Address:
STE. 102
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67218-3039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-219-3571
Provider Business Practice Location Address Fax Number:
316-219-3573
Provider Enumeration Date:
01/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364S00000X , with the licence number:  74122 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9383 . This is a "PREFERRED HEALTH CARE ID" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 436680 . This is a "FIRST GUARD - MEDICAID" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 207996 . This is a "HEALTH PARTNERS OF KANSAS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 3413735 . This is a "CIGNA INS ID" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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