Provider Demographics
NPI:1588343818
Name:HAGELINE, MANDI LYNN (PMHNP, MSN, RN)
Entity type:Individual
Prefix:
First Name:MANDI
Middle Name:LYNN
Last Name:HAGELINE
Suffix:
Gender:F
Credentials:PMHNP, MSN, RN
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1312 NICCON TRL
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-3606
Mailing Address - Country:US
Mailing Address - Phone:847-666-8926
Mailing Address - Fax:
Practice Address - Street 1:1400 E IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-3201
Practice Address - Country:US
Practice Address - Phone:630-837-9000
Practice Address - Fax:630-837-9275
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL041392703363LP0808X
IL209028229363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health