| Doctor Name: | ALISSA HAGEN |
| NPI Number: | 1164828513 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | AGPCNP-BC |
| License Number: | 4704286259 |
| Business Practice Address: | 19725 Allen Rd Ste 102 Brownstown Twp, MI - 481831090 |
| Business Phone Number: | 7344797246 |
| Business Fax Number: | 7344790214 |
| Mailing Address: | 19725 Allen Rd, Ste 102 BROWNSTOWN TWP |
| State: | MI |
| Postal Code: | 481831090 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/12/2014 |
| NPI Last Update Date: | 11/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 4704286259 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |