Provider Demographics
NPI:1841296910
Name:HAEG, EILEEN JOHANNA (PA-C)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:JOHANNA
Last Name:HAEG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 ABBEY RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56321-7777
Mailing Address - Country:US
Mailing Address - Phone:320-263-3142
Mailing Address - Fax:320-363-3124
Practice Address - Street 1:112 ABBEY RD
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:MN
Practice Address - Zip Code:56321-7777
Practice Address - Country:US
Practice Address - Phone:320-263-3124
Practice Address - Fax:320-363-3124
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN9262363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP26988OtherHEALTH PARTNERS
MN0115114OtherMEDICA
MN83A20HAOtherBCBS PROVIDER NUMBER
MN989631015831OtherPREFERRED ONE
MN7926656100Medicaid
MNP07733Medicare UPIN