Provider Demographics
NPI:1649739988
Name:HAGAN, ELIZABETH ANNE
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:HAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22635 NE MARKETPLACE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-5886
Mailing Address - Country:US
Mailing Address - Phone:425-898-7408
Mailing Address - Fax:425-898-7409
Practice Address - Street 1:22635 NE MARKETPLACE DR
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-5885
Practice Address - Country:US
Practice Address - Phone:425-898-7408
Practice Address - Fax:425-898-7409
Is Sole Proprietor?:No
Enumeration Date:2019-03-17
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61296052208000000X, 208000000X
MO2020031769208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics