Individual
MR. BENNY RAY HAGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1995 WEST RIDGE ROAD, WYTHEVILLE, VA 24382
(276) 223-1983
(276) 223-1316
Mailing address
1995 WEST RIDGE ROAD, WYTHEVILLE, VA 24382
(276) 223-1983
(276) 223-1316
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
0001056493
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500019629
RAILROAD MEDICARE
—
01
—
TN0102
JOHN DEERE HEALTH
—
Enumeration date
11/17/2006
Last updated
08/13/2010
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