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Individual

SUE ELLEN HAGIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
301 RANDOLPH ST, DENTON, MD 21629-1243
(410) 479-4306
(410) 479-1714
Mailing address
301 RANDOLPH ST, DENTON, MD 21629-1243
(410) 479-4306
(410) 479-1714

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
0024164940
VA
363LF0000X
Family Nurse Practitioner
Primary
R039951
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
206378
PRIORITY PARTNERS
MD
01
521116591
COVENTRY
MD
05
784381000
MD
01
89623401
CAREFIRST BC/BS RENDERING
MD
01
T5880041
CF BC/BS GRP/GHMSI/BL CHO
MD
Enumeration date
01/04/2006
Last updated
06/30/2008
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