Healthcare Provider Details

I. General information

NPI: 1104749514
Provider Name (Legal Business Name): KRISTEN MICHELE HAACK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 ROSEMARY LN NE
ROCHESTER MN
55906-4535
US

IV. Provider business mailing address

3031 ROSEMARY LN NE
ROCHESTER MN
55906-4535
US

V. Phone/Fax

Practice location:
  • Phone: 507-774-6630
  • Fax:
Mailing address:
  • Phone: 507-774-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number1262193
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: