Provider Demographics
NPI:1346645389
Name:HAGOOD, MARIANNE M (APRN)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:M
Last Name:HAGOOD
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Gender:F
Credentials:APRN
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Mailing Address - Street 1:955 RIBAUT RD
Mailing Address - Street 2:BMAC CREDENTIALING DEPARTMENT
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5441
Mailing Address - Country:US
Mailing Address - Phone:843-522-5674
Mailing Address - Fax:843-522-5678
Practice Address - Street 1:BEAUFORT MEMORIAL EXPRESS CARE & OCCUPATIONAL HEALTH
Practice Address - Street 2:974 RIBAUT ROAD
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5486
Practice Address - Country:US
Practice Address - Phone:843-524-3344
Practice Address - Fax:843-524-5574
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2018-09-18
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Provider Licenses
StateLicense IDTaxonomies
VA0024172154363LF0000X
SC22013363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC22013OtherSTATE LICENSE NUMBER