Provider Demographics
NPI:1427130624
Name:HAGER, DENISE M (APRN)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:HAGER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:3 AUDUBON PLAZA DR
Practice Address - Street 2:SUITE 430
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1300
Practice Address - Country:US
Practice Address - Phone:502-636-4900
Practice Address - Fax:502-636-4901
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004611363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50030511OtherPASSPORT/PASSPORT ADVANTAGE - NOTC
KY000000684231OtherANTHEM - NOTC
KY7100021680Medicaid
KY000057058POtherHUMANA - NOTC
KY103858OtherSIHO - NOTC
KY3272494OtherCIGNA - NOTC
KY1284534Medicare PIN
KYP00926069Medicare PIN
KY103858OtherSIHO - NOTC
KY50030511OtherPASSPORT/PASSPORT ADVANTAGE - NOTC