Provider Demographics
NPI:1043739006
Name:HAUKE, ELIZABETH CHRISTINE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CHRISTINE
Last Name:HAUKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 CHERRY VALLEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:MAINE
Mailing Address - State:NY
Mailing Address - Zip Code:13802-1224
Mailing Address - Country:US
Mailing Address - Phone:607-759-9688
Mailing Address - Fax:
Practice Address - Street 1:556 CHERRY VALLEY HILL RD
Practice Address - Street 2:
Practice Address - City:MAINE
Practice Address - State:NY
Practice Address - Zip Code:13802
Practice Address - Country:US
Practice Address - Phone:607-759-9688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer