Provider Demographics
NPI:1831193358
Name:HAGADON-SZAKAL, GERRI LYNN (MSN, CNP, DNP, PMHNP)
Entity type:Individual
Prefix:
First Name:GERRI
Middle Name:LYNN
Last Name:HAGADON-SZAKAL
Suffix:
Gender:F
Credentials:MSN, CNP, DNP, PMHNP
Other - Prefix:
Other - First Name:GERRI
Other - Middle Name:L
Other - Last Name:HAGADON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:721 N SHIAWASSEE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1632
Mailing Address - Country:US
Mailing Address - Phone:989-725-8124
Mailing Address - Fax:989-723-1205
Practice Address - Street 1:721 N SHIAWASSEE ST STE 201
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1632
Practice Address - Country:US
Practice Address - Phone:989-725-8124
Practice Address - Fax:989-723-1205
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704152236363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1831193358Medicaid
MI0872212OtherBCBSM PIN
MI1831193358Medicaid
MIN90910003Medicare PIN
MI4174670Medicaid