| Doctor Name: | SANDY HAGENE |
| NPI Number: | 1184731671 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 112902 |
| Business Practice Address: | 102 Ozark Dr Cuba, MO - 65453 |
| Business Phone Number: | 5738856600 |
| Business Fax Number: | 5738856610 |
| Mailing Address: | 670 Mason Ridge Center Dr, Ste 300 SAINT LOUIS |
| State: | MO |
| Postal Code: | 631418573 |
| Phone Number: | 5738856600 |
| Fax Number: | 5738856610 |
| NPI Enumeration Date: | 08/23/2006 |
| NPI Last Update Date: | 02/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 112902 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |