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NPI Code Detail

MEDICARE: HEATHER L HAEGELE F.N.P.

MEDICARE: HEATHER L HAEGELE F.N.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse142540MO
2363LF0000XFamily Nurse Practitioner142540MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962595710
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER L HAEGELE F.N.P.
Provider Business Mailing Address
First Line : 3619 RICHARDSON SQUARE DR
Second Line : STE 170
City : ARNOLD
State : MO
Zip : 63010-6022
Country : US
Telephone Number : 636-717-6776
Fax Number : 314-525-4055
Provider Business Practice Location Address
First Line : 3619 RICHARDSON SQUARE DR
Second Line : SUITE 170
City : ARNOLD
State : MO
Zip : 63010-6022
Country : US
Telephone Number : 636-717-6776
Fax Number : 314-525-4055
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2006
Last Update Date : 03/14/2017

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