Provider Demographics
NPI:1790751683
Name:HAGOOD, VIRGINIA (CRNA)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:HAGOOD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:130 TOWN CENTER DRIVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1744
Mailing Address - Country:US
Mailing Address - Phone:248-585-8221
Mailing Address - Fax:248-585-8270
Practice Address - Street 1:3601 W. 13 MILE RD
Practice Address - Street 2:400 FSC-PCS
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6769
Practice Address - Country:US
Practice Address - Phone:248-423-2481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704134430367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4167587Medicaid
MI430F364420OtherBCBSM
MIR66346Medicare UPIN
MI430F364420OtherBCBSM