Provider Demographics
NPI:1972044014
Name:HABERLAND, RENEE (RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:HABERLAND
Suffix:
Gender:F
Credentials:RN, 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:W5107 TWIN CREEK RD # 5
Mailing Address - Street 2:
Mailing Address - City:MENOMINEE
Mailing Address - State:MI
Mailing Address - Zip Code:49858-9678
Mailing Address - Country:US
Mailing Address - Phone:906-792-8771
Mailing Address - Fax:
Practice Address - Street 1:S926 US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:STEPHENSON
Practice Address - State:MI
Practice Address - Zip Code:49887-8808
Practice Address - Country:US
Practice Address - Phone:906-753-4665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704309052163W00000X
WI144214163W00000X
MI4704309052NSA17253363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse