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Demi Elisabeth Hagen

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

8915 W Connell Ave, Wauwatosa, WI 53226-3067

(414) 266-2626 (414) 266-2000

PECOS Enrollment

This provider is enrolled in PECOS as DEMI ANAGNOUSTOPOLOUS.

Based on the most recent information from CMS, provider Demi Elisabeth Hagen is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1003392770
Provider Type
Individual
Full Name
Hagen, Demi Elisabeth
Credential
PA-C

Gender
Female
Sole Proprietor
No
Enumeration Date
7/16/2018
Last Updated
7/17/2024

Contact Information

Practice Location

8915 W Connell Ave, Wauwatosa, WI 53226-3067

(414) 266-2626

Unlisted Fax

Mailing Location

999 N 92nd St, Wauwatosa, WI 53226-4875

(414) 266-2000

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 4529-23 Wisconsin

Provider Identifiers

ID	Description	Issuer
ID 1003392770	Description Medicaid	Issuer Unlisted Wisconsin

Demi Elisabeth Hagen

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Kazik, Jacqueline

Bouton, Todd Andrew

Riesch, Judith M

Foley, Kaitlyn Nicole

Flatley, Ann M

Bindas, Julie Ann R

Safranek, Angela M

Guhl, Lauren A

Bisciglia, Elizabeth

Smith, Bente E