Provider Demographics
NPI:1942057062
Name:HAGERICH, PATRICIA SUE
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:SUE
Last Name:HAGERICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 ROUTE 20 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-3914
Mailing Address - Country:US
Mailing Address - Phone:304-439-1602
Mailing Address - Fax:
Practice Address - Street 1:102 TAMARACK DR
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-1244
Practice Address - Country:US
Practice Address - Phone:304-472-5616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide