Provider Demographics
NPI:1144618885
Name:HAUGO, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:HAUGO
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 1:110943 VON HERTZEN CIR
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2714
Mailing Address - Country:US
Mailing Address - Phone:763-219-6682
Mailing Address - Fax:
Practice Address - Street 1:4300 EDGEWOOD DR NE
Practice Address - Street 2:
Practice Address - City:SAINT MICHAEL
Practice Address - State:MN
Practice Address - Zip Code:55376-4588
Practice Address - Country:US
Practice Address - Phone:763-744-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNV542285958911363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner