1972994093 NPI number — KATIE HAGERSTROM MSN, APNP, AGPC-BC

Table of content: KATIE HAGERSTROM MSN, APNP, AGPC-BC (NPI 1972994093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972994093 NPI number — KATIE HAGERSTROM MSN, APNP, AGPC-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAGERSTROM
Provider First Name:
KATIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, APNP, AGPC-BC
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:
1972994093
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
253 PATRICIA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WRIGHTSTOWN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54180-1201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-512-6489
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1746 PAUL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAUKAUNA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54130-3014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-422-7402
Provider Business Practice Location Address Fax Number:
920-543-5288
Provider Enumeration Date:
02/11/2015

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: 207RG0300X , with the licence number:  16206-33 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com