Whittney Brooke Hagene, NP-C
Individual provider Active NPI Family Nurse Practitioner · Baldwin, IL
NPI 1639739766 · NPPES record last updated Jun 20, 2019
Key facts
- NPI
- 1639739766
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 209018929 (IL)
- Practice address
- 10749 Gander Hollow Rd
Baldwin, IL 62217-1502 - Phone
- (618) 889-9560
- NPI assigned
- Jun 20, 2019
- 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)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209018929 | IL | MD | Family Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209018929 | IL | Yes |
Addresses
Primary practice location
10749 Gander Hollow Rd
Baldwin, IL 62217-1502
Mailing address
10749 Gander Hollow Rd
Baldwin, IL 62217-1502
Phone (618) 889-9560
Other providers in Baldwin, IL
All providers in Baldwin, IL · Family Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2019. 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.