Individual
JACKIE JEAN HAGMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
25 1ST AVE NE STE 100, BUFFALO, MN 55313-1598
(763) 682-3005
Mailing address
25 1ST AVE NE STE 100, BUFFALO, MN 55313-1598
(763) 682-3005
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L515553
MN
Other
Enumeration date
10/03/2017
Last updated
10/03/2017
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