Provider Demographics
NPI:1609993476
Name:HAAGSMA, REBECCA J (LPN)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:J
Last Name:HAAGSMA
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 1:9996 S CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:HELTONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47436-9602
Mailing Address - Country:US
Mailing Address - Phone:812-837-9213
Mailing Address - Fax:
Practice Address - Street 1:6801 LAKE PLAZA DR
Practice Address - Street 2:SUITE B214
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4061
Practice Address - Country:US
Practice Address - Phone:317-578-8937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27040263A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse