Provider Demographics
NPI:1497002141
Name:HAACK, NATALIE (LPN)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:HAACK
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 1:919 BRITTANY DR
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-7628
Mailing Address - Country:US
Mailing Address - Phone:614-648-1906
Mailing Address - Fax:
Practice Address - Street 1:919 BRITTANY DR
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-7628
Practice Address - Country:US
Practice Address - Phone:614-648-1906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-099815164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse