Individual
TRACY LYN HAGADORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPM, LM
Contact information
Practice address
182 STATE STREET, EAGLE, ID 83616
(208) 631-8910
Mailing address
806 EAGLE HILLS WAY, EAGLE, ID 83616-5212
(208) 631-8910
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
MID-86
ID
Other
Enumeration date
07/06/2018
Last updated
07/06/2018
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