Individual
GLORIA HAGBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15856 E 5TH ST, HAYWARD, WI 54843-1827
(715) 634-3000
(715) 634-7501
Mailing address
15856 E 5TH ST, HAYWARD, WI 54843-1827
(715) 634-3000
(715) 634-7501
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
39-1519694
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39-1519694
SPECIALIZED TRANSPORTATION
WI
Enumeration date
05/16/2014
Last updated
05/16/2014
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