Provider Demographics
NPI:1184928491
Name:HACKER, ELIZABETH LORA-NOEL (RN)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:LORA-NOEL
Last Name:HACKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:HACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:308 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:MINNEOTA
Mailing Address - State:MN
Mailing Address - Zip Code:56264-9248
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:106 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1034
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR197983-9163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse