Provider Demographics
NPI:1538556287
Name:HAGEN, DANA MARIE (CNM)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:HAGEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MARIE
Other - Last Name:BLUNDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1654 DIFFLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2237
Practice Address - Country:US
Practice Address - Phone:651-641-3900
Practice Address - Fax:651-641-3904
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNM 0254367A00000X
MN254367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife