Healthcare Provider Details

I. General information

NPI: 1164344065
Provider Name (Legal Business Name): MRS. TAYLOR ROSE HAACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15891 W JENNY LN
HAYWARD WI
54843-2594
US

IV. Provider business mailing address

15891 W JENNY LN
HAYWARD WI
54843-2594
US

V. Phone/Fax

Practice location:
  • Phone: 715-558-0750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number18794-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: