Phyllis A Hagan, ARNP
Individual provider Active NPI Family Nurse Practitioner · Raymond, NH
NPI 1619986361 · NPPES record last updated Oct 7, 2014
Key facts
- NPI
- 1619986361
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 016582-23 (NH)
- Practice address
- 128 Route 27
Raymond, NH 03077-1220 - Phone
- (603) 895-3351
- Fax
- (603) 895-0773
- NPI assigned
- Aug 5, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016582-21 | NH | MD | Community Health Nurse Practitioner |
| 016582-23 | NH | MD | Family Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Nurse Practitioner | 363LC1500X | 016582-21 | NH | |
| Family Nurse Practitioner | 363LF0000X | 016582-23 | NH | Yes |
Addresses
Primary practice location
128 Route 27
Raymond, NH 03077-1220
Mailing address
128 Route 27
Raymond, NH 03077-1220
Phone (603) 895-3351
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30009619 | Medicaid | NH | |
| 313480099 | Medicaid | ME | |
| 2301906YPNH01 | Other | NH | ANTHEM |
Other providers in Raymond, NH
- Neisha Tamara Gonzalez Torres
- Ana M Goubert
- Kaleigh Grady-Pacheco
- Gary A. Graham
- Granite State Disabilities Collective, LLC
- Stephanie Marie Hallenbeck
- Hampshire Family Dental
- Hannaford Bros Co LLC
- Amanda Hathaway
- Healthy Living Family Practice PA
All providers in Raymond, NH · Family Nurse Practitioner in New Hampshire
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 7, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.