MEDICARE: MRS. REBECCA J HAAGSMA LPN

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	164W00000X	Licensed Practical Nurse	27040263A	IN

General Provider Information

NPI Number	:	1609993476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA J HAAGSMA LPN

Provider Business Mailing Address
First Line	:	9996 S CHAPEL HILL RD
Second Line	:
City	:	HELTONVILLE
State	:	IN
Zip	:	47436-9602
Country	:	US
Telephone Number	:	812-837-9213
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 LAKE PLAZA DR
Second Line	:	SUITE B214
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-4061
Country	:	US
Telephone Number	:	317-578-8937
Fax Number	:

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

Provider Enumeration Date	:	03/24/2007
Last Update Date	:	07/08/2007

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