Provider Demographics
NPI:1093327454
Name:HAGAN, ELIZABETH ADJOA
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ADJOA
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 1:20 W MOSHOLU PKWY S APT 25C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1159
Mailing Address - Country:US
Mailing Address - Phone:929-239-9927
Mailing Address - Fax:
Practice Address - Street 1:20 W MOSHOLU PKWY S APT 25C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1159
Practice Address - Country:US
Practice Address - Phone:929-239-9927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243830164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse