Healthcare Provider Details

I. General information

NPI: 1093628075
Provider Name (Legal Business Name): MICHELE ANNE HAKE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14344 EMBASSY WAY
APPLE VALLEY MN
55124-5923
US

IV. Provider business mailing address

14344 EMBASSY WAY
APPLE VALLEY MN
55124-5923
US

V. Phone/Fax

Practice location:
  • Phone: 651-666-0430
  • Fax:
Mailing address:
  • Phone: 651-666-0430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number2135834
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: