Provider Demographics
NPI:1699385005
Name:HAGEN, BREA ANNE (APRN, FNP-C)
Entity type:Individual
Prefix:DR
First Name:BREA
Middle Name:ANNE
Last Name:HAGEN
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 DIVISION ST NW
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-2099
Mailing Address - Country:US
Mailing Address - Phone:701-214-2139
Mailing Address - Fax:
Practice Address - Street 1:90 DIVISION ST NW
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-2099
Practice Address - Country:US
Practice Address - Phone:701-214-2139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-01
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR34753363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care