Provider Demographics
NPI:1063741973
Name:HAUPT, JOHN TERRILL (LPN)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:TERRILL
Last Name:HAUPT
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3096 DECLIFF RD N
Mailing Address - Street 2:
Mailing Address - City:NEW BLOOMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43341-9500
Mailing Address - Country:US
Mailing Address - Phone:740-262-0690
Mailing Address - Fax:
Practice Address - Street 1:3096 DECLIFF RD N
Practice Address - Street 2:
Practice Address - City:NEW BLOOMINGTON
Practice Address - State:OH
Practice Address - Zip Code:43341-9500
Practice Address - Country:US
Practice Address - Phone:740-262-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.131021.MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse