Provider Demographics
NPI:1386813269
Name:HAUGEBERG, KAREN (LMT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:HAUGEBERG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 NE 6TH PL
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-1383
Mailing Address - Country:US
Mailing Address - Phone:541-667-7276
Mailing Address - Fax:
Practice Address - Street 1:215 E MAIN ST
Practice Address - Street 2:STE D
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-1876
Practice Address - Country:US
Practice Address - Phone:541-667-7276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14060174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist