Provider Demographics
NPI:1972994093
Name:HAGERSTROM, KATIE (MSN, APNP, AGPC-BC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:HAGERSTROM
Suffix:
Gender:F
Credentials:MSN, APNP, AGPC-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 PATRICIA LN
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:54180-1201
Mailing Address - Country:US
Mailing Address - Phone:920-512-6489
Mailing Address - Fax:
Practice Address - Street 1:253 PATRICIA LN
Practice Address - Street 2:
Practice Address - City:WRIGHTSTOWN
Practice Address - State:WI
Practice Address - Zip Code:54180-1201
Practice Address - Country:US
Practice Address - Phone:920-512-6489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI199212-30163W00000X
WI16206-33207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No163W00000XNursing Service ProvidersRegistered Nurse