Provider Demographics
NPI:1477738094
Name:HAEFNER, IRENE S (RN, CDE)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:S
Last Name:HAEFNER
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 ELMWOOD AVE
Mailing Address - Street 2:KENMORE MERCY HOSPITAL
Mailing Address - City:KENMORE
Mailing Address - State:NE
Mailing Address - Zip Code:14217-1304
Mailing Address - Country:US
Mailing Address - Phone:716-447-6273
Mailing Address - Fax:716-447-6052
Practice Address - Street 1:2950 ELMWOOD AVE
Practice Address - Street 2:KENMORE MERCY HOSPITAL
Practice Address - City:KENMORE
Practice Address - State:NE
Practice Address - Zip Code:14217-1304
Practice Address - Country:US
Practice Address - Phone:716-447-6273
Practice Address - Fax:716-447-6052
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY369701-1163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000526864001OtherBCBS KENMORE MERCY
NY000526864002OtherBCBS SISTERS HOSPITAL