Provider Demographics
NPI:1033509856
Name:HAGL, DIANNA JEAN (CNM)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:JEAN
Last Name:HAGL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11730 BRIDGE HAMPTON
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3203
Mailing Address - Country:US
Mailing Address - Phone:210-416-4929
Mailing Address - Fax:
Practice Address - Street 1:11730 BRIDGE HAMPTON
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3203
Practice Address - Country:US
Practice Address - Phone:210-416-4929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-01
Last Update Date:2015-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127357367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife