Provider Demographics
NPI:1558623264
Name:HAEGELAND, MARY PATRICIA (LPN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:HAEGELAND
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 1:4 LISA CT
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11724-2409
Mailing Address - Country:US
Mailing Address - Phone:631-367-0231
Mailing Address - Fax:
Practice Address - Street 1:4 LISA CT
Practice Address - Street 2:
Practice Address - City:COLD SPRING HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11724-2409
Practice Address - Country:US
Practice Address - Phone:631-367-0231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-10
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243636-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse