Connie Hagan, CRNP
Individual provider Active NPI Family Nurse Practitioner · Slippery Rock, PA
NPI 1669680393 · NPPES record last updated Jun 11, 2008
Key facts
- NPI
- 1669680393
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- RN199361L (PA)
- Practice address
- 565 Kelly Blvd
Slippery Rock, PA 16057-1155 - Phone
- (724) 794-4023
- Fax
- (724) 794-3675
- NPI assigned
- May 18, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060201000243 | PA | Practitioner - Nurse Practitioner | 0345254157 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN199361L | PA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Upmc Community Medicine, Inc | Current | Accepting new patients | |
| Upmc Community Medicine Inc | Current |
Accepting new patients | |
| Upmc Community Medcine Inc | Current |
Accepting new patients | |
| Upmc Northwest | Past | Accepting new patients | |
| Northwest Eye Associates Inc | Past | Accepting new patients | |
| Slippery Rock Family Medicine Center P.C. | Past | Accepting new patients |
Locations
875 N Hermitage Rd
Ste 3
Hermitage, PA 16148
Phone (724) 347-4622
339 6th Ave
Fl 5
Pittsburgh, PA 15222
Phone (412) 560-8762
2 Hot Metal St
Fl 3
Pittsburgh, PA 15203
Phone (412) 432-5869
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN199361L | PA | Yes |
Addresses
Primary practice location
565 Kelly Blvd
Slippery Rock, PA 16057-1155
Mailing address
606 W Mercer Street Ext
Harrisville, PA 16038-1514
Phone (724) 735-4415
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HA925951 | Other | PA | HIGHMARK |
| 1991407 | Other | PA | HIGHMARK |
Other providers in Slippery Rock, PA
- Steven Nelson Friebe
- Giant Eagle Inc
- Judith Lynne Gimble
- David Lyle Gordley
- James Gravener
- Emily Caroline Halle
- Susan Elizabeth Hannam
- Paul F Havey
- Health Buss LLC
- Patricia A Hemshrodt
All providers in Slippery Rock, PA · Family Nurse Practitioner in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.