Individual
DEMI ELISABETH HAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8915 W CONNELL AVE, WAUWATOSA, WI 53226-3067
(414) 266-2626
Mailing address
999 N 92ND ST, WAUWATOSA, WI 53226-4875
(414) 266-2000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4529-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003392770
—
WI
Enumeration date
07/16/2018
Last updated
07/17/2024
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