Provider Demographics
NPI:1225118078
Name:HAACK, KATHRYN ANN (ARNP - FNP-C)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ANN
Last Name:HAACK
Suffix:
Gender:F
Credentials:ARNP - FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 3128
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102
Mailing Address - Country:US
Mailing Address - Phone:712-239-4702
Mailing Address - Fax:712-239-0616
Practice Address - Street 1:2720 STONE PARK BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51102
Practice Address - Country:US
Practice Address - Phone:712-239-4702
Practice Address - Fax:712-239-0616
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-055923363L00000X
IAA055923363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0092080Medicaid
IA13642Medicare ID - Type Unspecified
S85900Medicare UPIN
IA161802Medicare ID - Type Unspecified