Provider Demographics
NPI:1437902764
Name:HADERSBECK, JOAN R
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:R
Last Name:HADERSBECK
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 1:218 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1224
Mailing Address - Country:US
Mailing Address - Phone:616-481-1177
Mailing Address - Fax:
Practice Address - Street 1:218 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1224
Practice Address - Country:US
Practice Address - Phone:616-481-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1214531282374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide