Healthcare Provider Details

I. General information

NPI: 1629387055
Provider Name (Legal Business Name): JULIE M HAIBACH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STATE STREET SUITE 400A
ERIE PA
16507-1478
US

IV. Provider business mailing address

717 STATE STREET SUITE 16, LL
ERIE PA
16501-1360
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-6997
  • Fax: 814-877-6356
Mailing address:
  • Phone: 814-877-7100
  • Fax: 814-877-7293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN548061
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: