Provider Demographics
NPI:1598715849
Name:HAGER, CAROL A (CRNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:HAGER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STATE ST STE 107
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1428
Mailing Address - Country:US
Mailing Address - Phone:814-877-3900
Mailing Address - Fax:814-877-3950
Practice Address - Street 1:300 STATE ST STE 107
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1428
Practice Address - Country:US
Practice Address - Phone:814-877-3900
Practice Address - Fax:814-877-3950
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009168363L00000X, 363L00000X, 363LF0000X
PARN 182828L163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA25-1889691OtherTAX ID
PAQ74400Medicare UPIN
PA106214E7CMedicare PIN