Provider Demographics
NPI:1053489351
Name:HAUCK, NICOLE MARIA-PHYLLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARIA-PHYLLIS
Last Name:HAUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 W 7TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-1100
Mailing Address - Country:US
Mailing Address - Phone:541-682-3550
Mailing Address - Fax:
Practice Address - Street 1:151 W 7TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-1100
Practice Address - Country:US
Practice Address - Phone:541-682-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5217208000000X
ORMD150739208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics