Healthcare Provider Details

I. General information

NPI: 1447951710
Provider Name (Legal Business Name): BROOKE HAESEMEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 SNELLING AVE
MINNEAPOLIS MN
55404-3157
US

IV. Provider business mailing address

2312 SNELLING AVE
MINNEAPOLIS MN
55404-3157
US

V. Phone/Fax

Practice location:
  • Phone: 612-314-1022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: