Provider Demographics
NPI:1285347039
Name:HAGAN, NATASHA L (LPN)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:L
Last Name:HAGAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 FLOWER CITY PARK
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-3037
Mailing Address - Country:US
Mailing Address - Phone:585-500-1054
Mailing Address - Fax:
Practice Address - Street 1:98 FLOWER CITY PARK
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-3037
Practice Address - Country:US
Practice Address - Phone:585-500-1054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341948164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse