Provider Demographics
NPI:1477531077
Name:HAGIE, SUE ELLEN (NP)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ELLEN
Last Name:HAGIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:SUE
Other - Middle Name:ELLEN
Other - Last Name:HAGIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:301 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-1243
Mailing Address - Country:US
Mailing Address - Phone:410-479-4306
Mailing Address - Fax:410-479-1714
Practice Address - Street 1:301 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-1243
Practice Address - Country:US
Practice Address - Phone:410-479-4306
Practice Address - Fax:410-479-1714
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164940363LF0000X
MDR039951363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD521116591OtherCOVENTRY
MD521116591OtherTRICARE
MDT5880041OtherCF BC/BS GRP/GHMSI/BL CHO
MD521116591OtherNCPPO
MD89623401OtherCAREFIRST BC/BS RENDERING
MD206378OtherPRIORITY PARTNERS
MD521116591OtherINFORMED
MD521116591OtherCIGNA
MD784381000Medicaid
MD521116591OtherMARYLAND PHYSICIANS CARE
MD89623401OtherCAREFIRST BC/BS RENDERING
MD206378OtherPRIORITY PARTNERS