Provider Demographics
NPI:1114013265
Name:HAGMANN, SUSAN KATHRINE (BSN,RN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KATHRINE
Last Name:HAGMANN
Suffix:
Gender:F
Credentials:BSN,RN
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:KATHRINE
Other - Last Name:HAGMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN,RN
Mailing Address - Street 1:2212 RIDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-9616
Mailing Address - Country:US
Mailing Address - Phone:715-877-2007
Mailing Address - Fax:
Practice Address - Street 1:1 ROCK IS
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61299-7350
Practice Address - Country:US
Practice Address - Phone:309-782-6856
Practice Address - Fax:309-782-0990
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI97672-030163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management