Provider Demographics
NPI:1740415215
Name:HAGENGRUBER, ERIN (BSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:HAGENGRUBER
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 KINGSBORO PARK
Mailing Address - Street 2:APT. 1
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 KINGSBORO PARK
Practice Address - Street 2:APT. 1
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2125
Practice Address - Country:US
Practice Address - Phone:617-320-7451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2258063163WG0000X
IDN-32951163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice