Provider Demographics
NPI:1356346308
Name:NIELSEN-HAAK, LAURIE A (DPM)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:A
Last Name:NIELSEN-HAAK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 MICHIGAN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-2401
Mailing Address - Country:US
Mailing Address - Phone:937-419-8049
Mailing Address - Fax:937-419-8050
Practice Address - Street 1:915 MICHIGAN ST STE 100
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2401
Practice Address - Country:US
Practice Address - Phone:937-419-8049
Practice Address - Fax:937-419-8050
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-3195-N213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00248977OtherMEDICARE RAILROAD
OH2304303Medicaid
OH4082999Medicare PIN
OH4082997Medicare PIN
OHU90339Medicare UPIN
OH1128890001Medicare NSC
OH4082998Medicare PIN