Active NPI
Deborah M Hagedorn, LPN
- Licensed Practical Nurse
- Timberlake, OH
National Provider Identifier
1861547648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- PN. 116989 MEDS IV
- Practice address
- 58 E Shore Blvd
Timberlake, OH 44095-1903 - Phone
- (440) 953-0395
- NPI assigned
- Jan 24, 2007
- Last updated
- Jun 3, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN. 116989 MEDS IV | OH | Primary |
Addresses
Primary practice location
58 E Shore Blvd
Timberlake, OH 44095-1903
Mailing address
58 E Shore Blvd
Timberlake, OH 44095-1903
Phone (440) 953-0395
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2593671 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PN. 116989 MEDS IV | OH | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307059200000",
"number": "1861547648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "58 E SHORE BLVD",
"city": "TIMBERLAKE",
"state": "OH",
"postal_code": "440951903",
"telephone_number": "440-953-0395"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "58 E SHORE BLVD",
"city": "TIMBERLAKE",
"state": "OH",
"postal_code": "440951903",
"telephone_number": "440-953-0395"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAGEDORN",
"first_name": "DEBORAH",
"middle_name": "M",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-24",
"last_updated": "2011-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OH",
"license": "PN. 116989 MEDS IV",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2593671",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Timberlake, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.