Provider Demographics
NPI:1245976844
Name:HAUGEN, MARY K (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:HAUGEN
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10948 HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:LITCHVILLE
Mailing Address - State:ND
Mailing Address - Zip Code:58461-9516
Mailing Address - Country:US
Mailing Address - Phone:218-252-0786
Mailing Address - Fax:
Practice Address - Street 1:10948 HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:LITCHVILLE
Practice Address - State:ND
Practice Address - Zip Code:58461-9516
Practice Address - Country:US
Practice Address - Phone:218-252-0786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-07
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR33701363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily