Provider Demographics
NPI:1801868195
Name:HAUCH, LOIS E (FNP)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:E
Last Name:HAUCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LOIS
Other - Middle Name:
Other - Last Name:HAUCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:2860 CREEKSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8442
Mailing Address - Country:US
Mailing Address - Phone:541-779-8367
Mailing Address - Fax:541-618-6351
Practice Address - Street 1:2860 CREEKSIDE CIR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8442
Practice Address - Country:US
Practice Address - Phone:541-779-8367
Practice Address - Fax:541-618-6351
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR292856Medicaid
109832Medicare ID - Type Unspecified
S92247Medicare UPIN