Provider Demographics
NPI:1558679126
Name:HAECKER, NANCI K (CNP)
Entity Type:Individual
Prefix:MS
First Name:NANCI
Middle Name:K
Last Name:HAECKER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:NANCI
Other - Middle Name:K
Other - Last Name:CLUXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1450 COLUMBUS AVE
Mailing Address - Street 2:SUITE B 6-7-8
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-3701
Mailing Address - Country:US
Mailing Address - Phone:740-333-2236
Mailing Address - Fax:740-333-3881
Practice Address - Street 1:1510 COLUMBUS AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-1899
Practice Address - Country:US
Practice Address - Phone:740-333-3333
Practice Address - Fax:740-333-5171
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA. 11636-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0050522Medicaid
OHH369990Medicare PIN
OHHA20344Medicare PIN