Provider Demographics
NPI:1376704122
Name:HAEGELE, JULIE MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:MARIE
Last Name:HAEGELE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 705
Mailing Address - Street 2:4986 CTY RD 6 NW
Mailing Address - City:ANNADALE
Mailing Address - State:MN
Mailing Address - Zip Code:55358
Mailing Address - Country:US
Mailing Address - Phone:320-274-8060
Mailing Address - Fax:320-274-3123
Practice Address - Street 1:4986 CTY RD 6 NW
Practice Address - Street 2:
Practice Address - City:ANNADALE
Practice Address - State:MN
Practice Address - Zip Code:55358
Practice Address - Country:US
Practice Address - Phone:320-274-8060
Practice Address - Fax:320-274-3123
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL0324757164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse