Provider Demographics
NPI:1093384760
Name:HAENCHEN, ANNA MELISSA (RNFA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MELISSA
Last Name:HAENCHEN
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 LOPIN CT
Mailing Address - Street 2:
Mailing Address - City:FORISTELL
Mailing Address - State:MO
Mailing Address - Zip Code:63348-2640
Mailing Address - Country:US
Mailing Address - Phone:217-248-8531
Mailing Address - Fax:
Practice Address - Street 1:307 LOPIN CT
Practice Address - Street 2:
Practice Address - City:FORISTELL
Practice Address - State:MO
Practice Address - Zip Code:63348-2640
Practice Address - Country:US
Practice Address - Phone:217-248-8531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041411666163WR0006X
MO2020011785163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA