Provider Demographics
NPI:1528657707
Name:HAGGERTY, LYNETTE JO
Entity type:Individual
Prefix:MS
First Name:LYNETTE
Middle Name:JO
Last Name:HAGGERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368-2121
Mailing Address - Country:US
Mailing Address - Phone:701-208-1049
Mailing Address - Fax:
Practice Address - Street 1:413 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368-2121
Practice Address - Country:US
Practice Address - Phone:701-208-1049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant