Provider Demographics
NPI:1386758456
Name:HAGLER, PATRICIA DAWN (CFM)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:DAWN
Last Name:HAGLER
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 E 7720 S
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2650
Mailing Address - Country:US
Mailing Address - Phone:801-566-3677
Mailing Address - Fax:801-566-3677
Practice Address - Street 1:41 E 7720 S
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-2650
Practice Address - Country:US
Practice Address - Phone:801-566-3677
Practice Address - Fax:801-566-3677
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTF42592332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT201801529001Medicaid
UTM100141OtherFACILITY ACCREDITED ABC
UTCFM00931OtherABC CERT. FITTER MASTECT.
UTM100141OtherFACILITY ACCREDITED ABC