Provider Demographics
NPI:1952326795
Name:HAEFFELE, JOANNE (FNP PHD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:HAEFFELE
Suffix:
Gender:F
Credentials:FNP PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY OF NEW MEXICO
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-3984
Mailing Address - Fax:847-392-0036
Practice Address - Street 1:1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-3984
Practice Address - Fax:847-392-0036
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT278391-4405363LF0000X
IL209.008603363LF0000X
NMCNP-02488363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD2584Medicaid
UT1164672770Medicaid
UT000064931Medicare PIN
P00679721Medicare PIN
S72911Medicare UPIN
UT005508005Medicare ID - Type Unspecified