Healthcare Provider Details

I. General information

NPI: 1740519693
Provider Name (Legal Business Name): CATHERINE JO HAUCK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2009
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W GRAND AVE STE 2002
DAYTON OH
45405-4722
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 937-294-3611
  • Fax:
Mailing address:
  • Phone: 970-624-4451
  • Fax: 970-490-4199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.005127RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0010-02080
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.0051272RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: