Healthcare Provider Details

I. General information

NPI: 1922457803
Provider Name (Legal Business Name): HOLLY L HABERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 RIVERSIDE DR
WAUPACA WI
54981-1941
US

IV. Provider business mailing address

710 RIVERSIDE DR
WAUPACA WI
54981-1941
US

V. Phone/Fax

Practice location:
  • Phone: 715-256-3000
  • Fax: 715-256-3039
Mailing address:
  • Phone: 715-256-3000
  • Fax: 715-256-3039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number74008
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number74008
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number74008
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: