Provider Demographics
NPI:1245739960
Name:HAGAN, ANDREA MARY (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARY
Last Name:HAGAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:VENETTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:18941 MARIA DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-2165
Mailing Address - Country:US
Mailing Address - Phone:586-260-9505
Mailing Address - Fax:
Practice Address - Street 1:4986 N ADAMS RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48306-5017
Practice Address - Country:US
Practice Address - Phone:248-475-4301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704297105363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily