Provider Demographics
NPI:1205481223
Name:HAGEN, MARSHA LEE
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:LEE
Last Name:HAGEN
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 1:40573 STATE HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:ROSEAU
Mailing Address - State:MN
Mailing Address - Zip Code:56751-8405
Mailing Address - Country:US
Mailing Address - Phone:218-689-4493
Mailing Address - Fax:
Practice Address - Street 1:40573 STATE HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:ROSEAU
Practice Address - State:MN
Practice Address - Zip Code:56751-8405
Practice Address - Country:US
Practice Address - Phone:218-689-4493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider