Individual
ELLIE HAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
737 BROADWAY N, FARGO, ND 58102-4421
(701) 234-5932
Mailing address
737 BROADWAY N, FARGO, ND 58102-4421
(701) 234-5932
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2570
ND
Other
Enumeration date
08/25/2021
Last updated
08/25/2021
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