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General NPI Number Information
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NPI Number | 1841296910
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Entity Type | Individual
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Provider Name | EILEEN JOHANNA HAEG PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 112 ABBEY RD
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City | COLLEGEVILLE
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State | MN
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Zip | 56321-7777
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Country | US
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Telephone | 320-263-3124
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Fax | 320-363-3124
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Provider Business Mailing Address
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Address Line | 112 ABBEY RD
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City | COLLEGEVILLE
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State | MN
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Zip | 56321-7777
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Country | US
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Telephone | 320-263-3142
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Fax | 320-363-3124
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MN9262
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License Number State | MN
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