Provider Demographics
NPI:1144054503
Name:BLACK-HAGAMAN, CATHERINE TAYLOR (RN)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:TAYLOR
Last Name:BLACK-HAGAMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:TAYLOR
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:336 S JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85602-0810
Mailing Address - Country:US
Mailing Address - Phone:615-517-4732
Mailing Address - Fax:
Practice Address - Street 1:2800 E AJO WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-6204
Practice Address - Country:US
Practice Address - Phone:520-874-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000254548163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse