| NPI | 1689809055 |
|---|---|
| Former Name | BETHANY LYNN HAGEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1710I1003X Military Health Care Provider, Independent Duty Medical Technicians |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2009-05-28 |