Provider Demographics
NPI:1295179117
Name:HAGEN, AMBER LANAE (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LANAE
Last Name:HAGEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:BERNE
Mailing Address - State:IN
Mailing Address - Zip Code:46711-1338
Mailing Address - Country:US
Mailing Address - Phone:260-525-0989
Mailing Address - Fax:
Practice Address - Street 1:867 W WATER ST
Practice Address - Street 2:
Practice Address - City:BERNE
Practice Address - State:IN
Practice Address - Zip Code:46711-1338
Practice Address - Country:US
Practice Address - Phone:260-525-0989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28189195A163W00000X
174H00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula