Provider Demographics
NPI:1275124463
Name:HAUGEN, KARISSA ANN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:ANN
Last Name:HAUGEN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 E SUPERIOR ST STE 113
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2253
Mailing Address - Country:US
Mailing Address - Phone:218-310-8896
Mailing Address - Fax:
Practice Address - Street 1:925 E SUPERIOR ST STE 113
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2253
Practice Address - Country:US
Practice Address - Phone:218-310-8896
Practice Address - Fax:218-206-6276
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7999363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health