Provider Demographics
NPI:1104693555
Name:HAALCK, KRISTIE LYN (AGAC-NP)
Entity type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:LYN
Last Name:HAALCK
Suffix:
Gender:F
Credentials:AGAC-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:204 LAKEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8736
Mailing Address - Country:US
Mailing Address - Phone:231-758-4059
Mailing Address - Fax:
Practice Address - Street 1:560 W MITCHELL ST STE 125
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2276
Practice Address - Country:US
Practice Address - Phone:231-487-4029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704299670NSA230K7363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care