Individual
MRS. MARY CECIL HAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/ L
Contact information
Practice address
2615 MCCOY WAY, LOUISVILLE, KY 40205-2361
(502) 552-9209
Mailing address
9817 WHITE BLOSSOM BLVD, LOUISVILLE, KY 40241-4181
(502) 295-8673
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
R4368
KY
Other
Enumeration date
01/12/2011
Last updated
01/12/2011
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