Provider Demographics
NPI:1982866042
Name:HABERL, GINA LEE
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:LEE
Last Name:HABERL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 EVERGREEN CT
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1611
Mailing Address - Country:US
Mailing Address - Phone:618-939-8464
Mailing Address - Fax:
Practice Address - Street 1:108 EVERGREEN CT
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1611
Practice Address - Country:US
Practice Address - Phone:618-939-8464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist