Provider Demographics
NPI:1932829249
Name:HAUGEN, PATRICIA ELLAN
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELLAN
Last Name:HAUGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26601 54TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:BERTHOLD
Mailing Address - State:ND
Mailing Address - Zip Code:58718-9189
Mailing Address - Country:US
Mailing Address - Phone:701-240-6137
Mailing Address - Fax:
Practice Address - Street 1:26601 54TH AVE SW # NA
Practice Address - Street 2:
Practice Address - City:BERTHOLD
Practice Address - State:ND
Practice Address - Zip Code:58718-9189
Practice Address - Country:US
Practice Address - Phone:701-240-6137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant