Provider Demographics
NPI:1780875039
Name:HAGENS, DANYEL ANTOINETTE (MD)
Entity type:Individual
Prefix:DR
First Name:DANYEL
Middle Name:ANTOINETTE
Last Name:HAGENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DANYEL
Other - Middle Name:ANTOINETTE
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4517 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-5322
Mailing Address - Country:US
Mailing Address - Phone:504-302-7737
Mailing Address - Fax:504-302-7734
Practice Address - Street 1:4517 VETERANS MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-5322
Practice Address - Country:US
Practice Address - Phone:504-885-8601
Practice Address - Fax:504-885-8603
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1090263Medicaid