Provider Demographics
NPI:1891557583
Name:HAAG, SAMANTHA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HAAG
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IBCLC
Mailing Address - Street 1:1008 OLINDA CT
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-2617
Mailing Address - Country:US
Mailing Address - Phone:319-610-7125
Mailing Address - Fax:
Practice Address - Street 1:1008 OLINDA CT
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-2617
Practice Address - Country:US
Practice Address - Phone:319-610-7125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1133731163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant