Provider Demographics
NPI:1538941646
Name:HAGELMAN, SUSAN MARIE (CRNP PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:HAGELMAN
Suffix:
Gender:F
Credentials:CRNP PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BUSH TER
Mailing Address - Street 2:
Mailing Address - City:ST MICHAELS
Mailing Address - State:MD
Mailing Address - Zip Code:21663-2803
Mailing Address - Country:US
Mailing Address - Phone:410-226-6320
Mailing Address - Fax:
Practice Address - Street 1:104 BUSH TER
Practice Address - Street 2:
Practice Address - City:ST MICHAELS
Practice Address - State:MD
Practice Address - Zip Code:21663-2803
Practice Address - Country:US
Practice Address - Phone:410-226-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR221969363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health