Healthcare Provider Details

I. General information

NPI: 1972044014
Provider Name (Legal Business Name): RENEE HABERLAND RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S926 US HIGHWAY 41
STEPHENSON MI
49887-8808
US

IV. Provider business mailing address

W5107 TWIN CREEK RD # 5
MENOMINEE MI
49858-9678
US

V. Phone/Fax

Practice location:
  • Phone: 906-753-4665
  • Fax:
Mailing address:
  • Phone: 906-792-8771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704309052
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number144214
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704309052NSA17253
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: