Individual
MRS. KATHLEEN A HAGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
842 GRAY ST, HORICON, WI 53032-1715
(920) 643-7576
Mailing address
842 GRAY ST, HORICON, WI 53032-1715
(920) 643-7576
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
73123-030
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38286800
—
WI
Enumeration date
04/21/2008
Last updated
04/21/2008
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