Doctor Name: | GLORIA HAGBERG |
NPI Number: | 1033520622 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 39-1519694 |
Business Practice Address: | 15856 E 5th St Hayward, WI - 548431827 |
Business Phone Number: | 7156343000 |
Business Fax Number: | 7156347501 |
Mailing Address: | 15856 E 5th St, HAYWARD |
State: | WI |
Postal Code: | 548431827 |
Phone Number: | 7156343000 |
Fax Number: | 7156347501 |
NPI Enumeration Date: | 05/16/2014 |
NPI Last Update Date: | 05/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 172A00000X |
License Number: | 39-1519694 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Driver |
Taxonomy Specialization: | |
Taxonomy Definition: | A person employed to operate a motor vehicle as a carrier of persons or property. |