Provider Demographics
NPI:1487695714
Name:HAGEN, JOANNA MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:MARIE
Last Name:HAGEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:MARIE
Other - Last Name:NEWTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:9801 FRONTIER AVE SE
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-5200
Mailing Address - Country:US
Mailing Address - Phone:425-831-2300
Mailing Address - Fax:425-831-2361
Practice Address - Street 1:35020 SE KINSEY ST
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-8992
Practice Address - Country:US
Practice Address - Phone:425-396-7682
Practice Address - Fax:425-396-7694
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006257207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP97765Medicare UPIN
G8864750Medicare PIN