MEDICARE: MR. CHAD LOUIS HAUGE RN

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	163W00000X	Registered Nurse	R036697	SD

General Provider Information

NPI Number	:	1285893438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHAD LOUIS HAUGE RN

Provider Business Mailing Address
First Line	:	3159 TURTLE CREEK CT
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57703-6439
Country	:	US
Telephone Number	:	605-791-2845
Fax Number	:

Provider Business Practice Location Address
First Line	:	3159 TURTLE CREEK CT
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57703-6439
Country	:	US
Telephone Number	:	605-791-2845
Fax Number	:

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

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	06/03/2008

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