Provider Demographics
NPI:1871858621
Name:O'HAGAN, MARION ALIDA (APRN)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:ALIDA
Last Name:O'HAGAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 DUTCHMANS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3271
Mailing Address - Country:US
Mailing Address - Phone:502-456-6200
Mailing Address - Fax:502-456-6655
Practice Address - Street 1:6200 DUTCHMANS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3271
Practice Address - Country:US
Practice Address - Phone:502-456-6200
Practice Address - Fax:502-456-6655
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007449363L00000X, 363LF0000X
IN71011784A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017533400Medicaid