Individual
BRENDA HAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
150 MUNDY ST, WILKES BARRE, PA 18702-6830
(570) 824-0930
(570) 824-7755
Mailing address
150 MUNDY ST, WILKES BARRE, PA 18702-6830
(570) 824-0930
(570) 824-7755
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
TP-003758-B
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50076561
CAPITAL BLUE CROSS
PA
01
—
892898
BLUE CARE
PA
01
—
P00155573
RAILROAD MEDICARE
PA
Enumeration date
09/15/2005
Last updated
06/18/2009
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