Provider Demographics
NPI:1245505551
Name:HAGAN, MARYANN (RN)
Entity type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:
Last Name:HAGAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 MARATHON PKWY
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2042
Mailing Address - Country:US
Mailing Address - Phone:718-224-8060
Mailing Address - Fax:718-224-5914
Practice Address - Street 1:6125 MARATHON PKWY
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-2042
Practice Address - Country:US
Practice Address - Phone:718-224-8060
Practice Address - Fax:718-224-5914
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223030-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool