Provider Demographics
NPI:1588053490
Name:HAGENS, LIA MARIE
Entity type:Individual
Prefix:MRS
First Name:LIA
Middle Name:MARIE
Last Name:HAGENS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LIA
Other - Middle Name:MARIE
Other - Last Name:FOGGIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6197 KALENDA CT NE
Mailing Address - Street 2:APT 209
Mailing Address - City:ALBERTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55301-9608
Mailing Address - Country:US
Mailing Address - Phone:320-231-7860
Mailing Address - Fax:320-231-7888
Practice Address - Street 1:2200 23RD ST NE
Practice Address - Street 2:SUITE 1080
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-6605
Practice Address - Country:US
Practice Address - Phone:320-231-7860
Practice Address - Fax:320-231-7888
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN220339-7163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health