MEDICARE: BRENDA M HAUGEN LICENSED SPECIALIST

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	332S00000X	Hearing Aid Equipment	2212	MN

General Provider Information

NPI Number	:	1700933009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA M HAUGEN LICENSED SPECIALIST

Provider Business Mailing Address
First Line	:	2812 17TH AVE S STE E
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-4048
Country	:	US
Telephone Number	:	701-746-8421
Fax Number	:	701-746-4719

Provider Business Practice Location Address
First Line	:	2812 17TH AVE S STE E
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-4048
Country	:	US
Telephone Number	:	701-746-8421
Fax Number	:	701-746-4719

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	03/25/2010

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