Provider Demographics
NPI:1285020610
Name:HAGERMAN, MORGAN (RN)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:HAGERMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 CHILDRENS PLZ
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-1873
Mailing Address - Country:US
Mailing Address - Phone:937-641-5008
Mailing Address - Fax:937-641-5003
Practice Address - Street 1:1 CHILDRENS PLZ
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1873
Practice Address - Country:US
Practice Address - Phone:937-641-5008
Practice Address - Fax:937-641-5003
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH399362363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0143578Medicaid