Individual
MRS. BRENDA KAY HAGEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, APRN, BC FNP
Contact information
Practice address
701 LEWISTON ST, COTTONWOOD, ID 83522-9750
(208) 962-3267
(208) 962-2313
Mailing address
420 N. 2ND AVE, SANDPOINT, ID 83864
(208) 263-0450
(208) 962-2313
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP300A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
804211800
—
ID
Enumeration date
05/24/2005
Last updated
09/27/2019
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