Provider Demographics
NPI:1447596234
Name:HAGAN, LYDIA (LPN)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:HAGAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 W FERN AVE
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6518
Mailing Address - Country:US
Mailing Address - Phone:907-250-1599
Mailing Address - Fax:
Practice Address - Street 1:711 H ST
Practice Address - Street 2:STE 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3446
Practice Address - Country:US
Practice Address - Phone:907-770-0862
Practice Address - Fax:907-770-1730
Is Sole Proprietor?:No
Enumeration Date:2012-12-24
Last Update Date:2012-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6165164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse