Provider Demographics
NPI:1114379245
Name:HAGBERG, JANA
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:HAGBERG
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:PO BOX 702
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-0702
Mailing Address - Country:US
Mailing Address - Phone:918-232-8718
Mailing Address - Fax:
Practice Address - Street 1:360 S ZUNIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-2214
Practice Address - Country:US
Practice Address - Phone:918-232-8718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management