Provider Demographics
NPI:1366112229
Name:HAGEN, GINGER RENEE
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:RENEE
Last Name:HAGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 COLERIDGE AVE NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-2120
Mailing Address - Country:US
Mailing Address - Phone:234-430-2471
Mailing Address - Fax:
Practice Address - Street 1:831 COLERIDGE AVE NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-2120
Practice Address - Country:US
Practice Address - Phone:234-430-2471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health