Provider Demographics
NPI:1033937677
Name:HOAGLAND, STEPHANIE ROSE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ROSE
Last Name:HOAGLAND
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 1:160 TARPEN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-8575
Mailing Address - Country:US
Mailing Address - Phone:304-771-9542
Mailing Address - Fax:
Practice Address - Street 1:160 TARPEN RIDGE RD
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-8575
Practice Address - Country:US
Practice Address - Phone:304-771-9542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV125553494Medicaid
WV1821206228Medicaid
WV1356607394Medicaid