Provider Demographics
NPI:1932171493
Name:HAGAN, EVELYN D (ARNP)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:D
Last Name:HAGAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 WILSON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:NH
Mailing Address - Zip Code:03574-4328
Mailing Address - Country:US
Mailing Address - Phone:603-869-5709
Mailing Address - Fax:
Practice Address - Street 1:14 KING SQ
Practice Address - Street 2:
Practice Address - City:WHITEFIELD
Practice Address - State:NH
Practice Address - Zip Code:03598-3302
Practice Address - Country:US
Practice Address - Phone:603-837-2333
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0232012303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80000332Medicaid
S02422Medicare UPIN
NP0322Medicare ID - Type Unspecified