Provider Demographics
NPI:1467797142
Name:HAGEMAN, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HAGEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SMITH CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:66967-2605
Mailing Address - Country:US
Mailing Address - Phone:785-282-6656
Mailing Address - Fax:785-282-3301
Practice Address - Street 1:119 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITH CENTER
Practice Address - State:KS
Practice Address - Zip Code:66967-2605
Practice Address - Country:US
Practice Address - Phone:785-282-6656
Practice Address - Fax:785-282-3301
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS131148040221223D0001X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No1223D0001XDental ProvidersDentistDental Public Health