Provider Demographics
NPI:1679147334
Name:HAGAN, HEIDI LYNETTE (CNM)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNETTE
Last Name:HAGAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 JENNIFER CT STE B
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-7694
Mailing Address - Country:US
Mailing Address - Phone:717-218-9830
Mailing Address - Fax:717-218-9833
Practice Address - Street 1:2 JENNIFER CT STE B
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-7694
Practice Address - Country:US
Practice Address - Phone:717-218-9830
Practice Address - Fax:717-218-9833
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010628176B00000X, 367A00000X
367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife