Provider Demographics
NPI:1407894835
Name:LINK, MAUREEN HAGERTY (FNP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:HAGERTY
Last Name:LINK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10810 MALLARD CREEK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-9786
Practice Address - Country:US
Practice Address - Phone:704-510-8000
Practice Address - Fax:704-510-8006
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201371363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004824Medicaid
NC84635OtherBCBS
NC1407894835Medicaid
SCNP1710Medicaid
NCNC8868AMedicare PIN
NC84635OtherBCBS
NCP13195Medicare UPIN
NC2599339AMedicare PIN
SCNP1710Medicaid
NC1407894835Medicaid
NCNC8868EMedicare PIN
NCNC8868FMedicare PIN
NC2592612EMedicare PIN