Provider Demographics
NPI:1285621904
Name:HAGELBERG, JACQUELINE M (FNP)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:M
Last Name:HAGELBERG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 SUMMIT OAKS
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3261
Mailing Address - Country:US
Mailing Address - Phone:585-385-5788
Mailing Address - Fax:
Practice Address - Street 1:2101 LAC DEVILLE BLVD.
Practice Address - Street 2:GREATER ROCHESTER NEUROLOGY
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-546-3265
Practice Address - Fax:585-232-5158
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331417-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03096435Medicaid
J400003560Medicare PIN