Healthcare Provider Details

I. General information

NPI: 1578476651
Provider Name (Legal Business Name): MICHAEL HAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4464 S DIXIE HWY
MIDDLETOWN OH
45005-5464
US

IV. Provider business mailing address

5303 BARKWOOD DR
WEST CHESTER OH
45069-5004
US

V. Phone/Fax

Practice location:
  • Phone: 513-649-8008
  • Fax:
Mailing address:
  • Phone: 513-649-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0043470
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: