MEDICARE: MS. KATHRYN ANN HAACK ARNP - FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	A-055923	IA
2	363L00000X	Nurse Practitioner	A055923	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225118078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHRYN ANN HAACK ARNP - FNP-C

Provider Business Mailing Address
First Line	:	P.O. BOX 3128
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51102
Country	:	US
Telephone Number	:	712-239-4702
Fax Number	:	712-239-0616

Provider Business Practice Location Address
First Line	:	2720 STONE PARK BLVD
Second Line	:	SUITE 110
City	:	SIOUX CITY
State	:	IA
Zip	:	51102
Country	:	US
Telephone Number	:	712-239-4702
Fax Number	:	712-239-0616

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/06/2011

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