Provider Demographics
NPI:1932329430
Name:HAGLEY, CARMELLIA MARLINE
Entity Type:Individual
Prefix:MRS
First Name:CARMELLIA
Middle Name:MARLINE
Last Name:HAGLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 ST RT 141
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638
Mailing Address - Country:US
Mailing Address - Phone:740-533-2998
Mailing Address - Fax:740-533-2998
Practice Address - Street 1:275 N 3RD ST
Practice Address - Street 2:SHERMAN THOMPSON TOWERS
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638
Practice Address - Country:US
Practice Address - Phone:740-532-0694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
2696079Medicare UPIN