Individual
DEBORAH M HAGEDORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
58 E SHORE BLVD, TIMBERLAKE, OH 44095-1903
(440) 953-0395
Mailing address
58 E SHORE BLVD, TIMBERLAKE, OH 44095-1903
(440) 953-0395
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN. 116989 MEDS IV
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2593671
—
OH
Enumeration date
01/24/2007
Last updated
06/03/2011
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