Provider Demographics
NPI:1952588345
Name:HAGE, JANICE H (APRN-BC)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:H
Last Name:HAGE
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:ELAINE
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:424 SAINT GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6976
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2424 INDIA HOOK RD
Practice Address - Street 2:SUITE 120
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2784
Practice Address - Country:US
Practice Address - Phone:803-328-8255
Practice Address - Fax:803-328-8265
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5003891363LA2100X
SC3423363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC9144AOtherMEDICARE PTAN
NC7006373Medicaid