Provider Demographics
NPI:1881370096
Name:HAGGSTROM, ERIN MARIE (LPN, RMA, CNA)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:MARIE
Last Name:HAGGSTROM
Suffix:
Gender:F
Credentials:LPN, RMA, CNA
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:MARIE
Other - Last Name:WHITAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2521 N ELMS RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-9423
Mailing Address - Country:US
Mailing Address - Phone:866-498-3909
Mailing Address - Fax:
Practice Address - Street 1:2521 N ELMS RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-9423
Practice Address - Country:US
Practice Address - Phone:866-498-3909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703127703164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse