Provider Demographics
NPI:1811065766
Name:HAGEMEISTER, ERIN K (NP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:K
Last Name:HAGEMEISTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 1ST AVE NW
Mailing Address - Street 2:PO BOX 697
Mailing Address - City:KENMARE
Mailing Address - State:ND
Mailing Address - Zip Code:58746-7104
Mailing Address - Country:US
Mailing Address - Phone:701-385-4344
Mailing Address - Fax:701-385-4295
Practice Address - Street 1:922 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:ND
Practice Address - Zip Code:58341-1524
Practice Address - Country:US
Practice Address - Phone:701-324-4856
Practice Address - Fax:701-324-4858
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR28260363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19773Medicaid
ND24680OtherBLUE CROSS BLUE SHIELD
ND24680OtherBLUE CROSS BLUE SHIELD
ND19773Medicaid