Provider Demographics
NPI:1407234727
Name:HAGANS, CHERISE (NP)
Entity Type:Individual
Prefix:MS
First Name:CHERISE
Middle Name:
Last Name:HAGANS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:CHERISE
Other - Middle Name:
Other - Last Name:HAGANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:3105 KINGSWAY RD
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-2030
Mailing Address - Country:US
Mailing Address - Phone:240-393-2314
Mailing Address - Fax:
Practice Address - Street 1:3105 KINGSWAY RD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-2030
Practice Address - Country:US
Practice Address - Phone:240-393-2314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR161898363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD097118900Medicaid