Provider Demographics
NPI:1750972030
Name:HAGERTY, ANGELA MARIE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:HAGERTY
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 NW HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-6008
Mailing Address - Country:US
Mailing Address - Phone:541-916-8530
Mailing Address - Fax:541-916-8533
Practice Address - Street 1:1619 NW HAWTHORNE AVE STE 204
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-6009
Practice Address - Country:US
Practice Address - Phone:419-168-5305
Practice Address - Fax:541-916-8533
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704321277NSA2102U363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily