Individual
JOAN E HAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
301 E MIEL DE LUNA AVE, TUCUMCARI, NM 88401-3810
(505) 461-0141
(505) 461-4272
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-5356
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
549
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
NM
Enumeration date
04/26/2007
Last updated
07/08/2007
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