Provider Demographics
NPI:1013086271
Name:HAEN, LINDA SUSAN (FNPC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUSAN
Last Name:HAEN
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2641 DEVELOPMENT DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311
Mailing Address - Country:US
Mailing Address - Phone:920-338-6868
Mailing Address - Fax:920-338-6869
Practice Address - Street 1:2641 DEVELOPMENT DRIVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311
Practice Address - Country:US
Practice Address - Phone:920-338-6868
Practice Address - Fax:920-338-6869
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2066033363LX0001X
WI74273-30363L00000X
WI2066-033363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43977500Medicaid
WI43977500Medicaid
P73555Medicare UPIN