Provider Demographics
NPI:1588008551
Name:HAGEN, CYNTHIA BETH (RN, PMHNP-BC)
Entity Type:Individual
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First Name:CYNTHIA
Middle Name:BETH
Last Name:HAGEN
Suffix:
Gender:F
Credentials:RN, PMHNP-BC
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Mailing Address - Street 1:151 S 4TH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4715
Mailing Address - Country:US
Mailing Address - Phone:701-795-3000
Mailing Address - Fax:701-795-3050
Practice Address - Street 1:1521B 24TH AVE S STE 203
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6775
Practice Address - Country:US
Practice Address - Phone:701-885-7920
Practice Address - Fax:701-757-0859
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NDR31494163WP0807X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent