Healthcare Provider Details

I. General information

NPI: 1851107171
Provider Name (Legal Business Name): CORA LEE HASELOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E CENTRAL ENTRANCE STE 215
DULUTH MN
55811-5520
US

IV. Provider business mailing address

1109 N 8TH AVE E
DULUTH MN
55805-1409
US

V. Phone/Fax

Practice location:
  • Phone: 218-722-0833
  • Fax:
Mailing address:
  • Phone: 218-260-5055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12360
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: