Provider Demographics
NPI:1700040714
Name:HABAS, DORIS ANN (LPN PRIVATE DUTY NUR)
Entity Type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:ANN
Last Name:HABAS
Suffix:
Gender:F
Credentials:LPN PRIVATE DUTY NUR
Other - Prefix:
Other - First Name:DORIS
Other - Middle Name:A
Other - Last Name:IVERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30480 TODY ROAD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:WI
Mailing Address - Zip Code:54856
Mailing Address - Country:US
Mailing Address - Phone:715-765-4814
Mailing Address - Fax:
Practice Address - Street 1:29250 HWY E
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:WI
Practice Address - Zip Code:54856
Practice Address - Country:US
Practice Address - Phone:715-765-4791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25473-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35059800Medicaid