Provider Demographics
NPI:1760126221
Name:HAGEN, RANDI (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:
Last Name:HAGEN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MRS
Other - First Name:RANDI
Other - Middle Name:
Other - Last Name:EDENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9049 SPRINGBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-4926
Mailing Address - Country:US
Mailing Address - Phone:513-349-4027
Mailing Address - Fax:
Practice Address - Street 1:9049 SPRINGBORO PIKE
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-4926
Practice Address - Country:US
Practice Address - Phone:937-759-0545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.388342163WP0808X
OHAPRN.CNP.0032485363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health