Individual
KELLY MARIE HAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
480 E DIVISION ST, FOND DU LAC, WI 54935-3734
(920) 926-4100
(920) 926-4190
Mailing address
480 E DIVISION ST, FOND DU LAC, WI 54935-3734
(920) 926-4100
(920) 926-4190
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
10452-33
WI
363LF0000X
Family Nurse Practitioner
Primary
10452-33
WI
Other
Enumeration date
10/06/2020
Last updated
08/03/2022
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