Provider Demographics
NPI:1265459937
Name:HAUGEN, NANCY ANN (LAT)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANN
Last Name:HAUGEN
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-2216
Mailing Address - Country:US
Mailing Address - Phone:262-473-7842
Mailing Address - Fax:
Practice Address - Street 1:1461 W MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1568
Practice Address - Country:US
Practice Address - Phone:262-473-5599
Practice Address - Fax:262-473-8522
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI61-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer