Provider Demographics
NPI:1932590320
Name:HAGAN, SUSANNE (RN)
Entity Type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:
Last Name:HAGAN
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 1:20 MEADOWRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-9694
Mailing Address - Country:US
Mailing Address - Phone:302-381-2608
Mailing Address - Fax:
Practice Address - Street 1:20 MEADOWRIDGE LN
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-9694
Practice Address - Country:US
Practice Address - Phone:302-381-2608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-07
Last Update Date:2015-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0019982163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse