Sandra Jean Hagen, RD
Individual provider Active NPI Registered Dietitian · Cresco, IA
NPI 1982818639 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1982818639
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 00371 (IA)
- Practice address
- 235 8TH Ave W
Cresco, IA 52136-1062 - Phone
- (563) 547-2101
- Fax
- (563) 547-3448
- NPI assigned
- May 10, 2007
- 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 |
|---|---|---|---|
| 00371 | IA | MD | Audiologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 00371 | IA | Yes |
Addresses
Primary practice location
235 8TH Ave W
Cresco, IA 52136-1062
Mailing address
235 8TH Ave W
Cresco, IA 52136-1062
Phone (563) 547-2101
Other providers in Cresco, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. 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.