Basic Information
| Provider Information | |||||||||
| NPI: | 1568749042 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAGEN | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | LILLY | ||||||||
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| Credential: | RN, MSN, CPNP-AC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6300 LA CALMA DRIVE | ||||||||
| Address2: | EMERGENCY SERVICE PARTNERS | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124528533 | ||||||||
| FaxNumber: | 5126100392 | ||||||||
| Practice Location | |||||||||
| Address1: | 4900 MUELLER BLVD | ||||||||
| Address2: | DELL CHILDRENS MEDICAL CENTER OF CENTRAL TEXAS | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123240150 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2011 | ||||||||
| LastUpdateDate: | 11/10/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 530372 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.