Individual
BRENDA L HAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
555 E CHEVES ST, FLORENCE, SC 29506-2617
(843) 661-6215
(919) 873-9821
Mailing address
3100 SPRING FOREST RD, SUITE 130, RALEIGH, NC 27616-2880
(919) 882-0705
(919) 873-9821
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
34004110
OH
207L00000X
Anesthesiology Physician
Primary
36203
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0636162
—
OH
Enumeration date
03/09/2006
Last updated
11/16/2016
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