Provider Demographics
NPI:1730435058
Name:HAGGERTY, NANCY ELIZABETH
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ELIZABETH
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 1:10750 S TIMBERLEE DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-8405
Mailing Address - Country:US
Mailing Address - Phone:231-709-0246
Mailing Address - Fax:231-709-0246
Practice Address - Street 1:10750 S TIMBERLEE DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-8405
Practice Address - Country:US
Practice Address - Phone:231-709-0246
Practice Address - Fax:231-709-0246
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007325171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor