Provider Demographics
NPI:1770125593
Name:HAGERMAN, LISA (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HAGERMAN
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 1:3674 DEXTER ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207
Mailing Address - Country:US
Mailing Address - Phone:970-389-8412
Mailing Address - Fax:
Practice Address - Street 1:3674 DEXTER ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207
Practice Address - Country:US
Practice Address - Phone:970-389-8412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95127678163W00000X
MN2458551163W00000X
NJ26NR20034100163W00000X
MARN2305002163W00000X
NY764150163W00000X
OR201808295RN163W00000X
PARN706156163W00000X
RIRN59742163W00000X
WARN60965213163W00000X
CO117960163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse