Provider Demographics
NPI:1689043119
Name:HAPPE, SALLY
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:HAPPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 E MEDICINE LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2307
Mailing Address - Country:US
Mailing Address - Phone:763-559-1883
Mailing Address - Fax:
Practice Address - Street 1:3409 E MEDICINE LAKE BLVD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2307
Practice Address - Country:US
Practice Address - Phone:763-559-1883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility