Individual
SANDY R HAGENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
102 OZARK DR, CUBA, MO 65453
(573) 885-6600
(573) 885-6610
Mailing address
102 OZARK DR STE B, CUBA, MO 65453-1664
(573) 885-6600
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
112906
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
424651305
—
MO
Enumeration date
08/23/2006
Last updated
05/13/2021
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