Provider Demographics
NPI:1922640507
Name:HAUG, MANDY JO (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:MANDY
Middle Name:JO
Last Name:HAUG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 SUGAR DR
Mailing Address - Street 2:
Mailing Address - City:ARGUSVILLE
Mailing Address - State:ND
Mailing Address - Zip Code:58005-9616
Mailing Address - Country:US
Mailing Address - Phone:701-371-5878
Mailing Address - Fax:
Practice Address - Street 1:3280 6TH ST E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-5459
Practice Address - Country:US
Practice Address - Phone:701-532-1563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR34595363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily