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General NPI Number Information
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NPI Number | 1649524588
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Entity Type | Individual
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Provider Name | CATHERINE MARIE EVANGELISTA HAUGEN ANP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 03/24/2021
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Provider Practice Location Address
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Address Line | 39450 W 12 MILE RD
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City | NOVI
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State | MI
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Zip | 48377-3600
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Country | US
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Telephone | 248-661-7393
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Fax | 248-344-4103
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Provider Business Mailing Address
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Address Line | 39450 W12 MILE ROAD
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City | NOVI
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State | MI
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Zip | 48377
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Country | US
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Telephone | 842-661-7393
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Fax | 842-344-4109
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704163632
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704163632
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License Number State | MI
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