Provider Demographics
NPI:1841850021
Name:HAUGLAND, RAEVYN
Entity type:Individual
Prefix:
First Name:RAEVYN
Middle Name:
Last Name:HAUGLAND
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 1:115 VIVIAN ST W
Mailing Address - Street 2:
Mailing Address - City:PARK RIVER
Mailing Address - State:ND
Mailing Address - Zip Code:58270-4540
Mailing Address - Country:US
Mailing Address - Phone:701-284-4682
Mailing Address - Fax:701-284-4581
Practice Address - Street 1:115 VIVIAN ST W
Practice Address - Street 2:
Practice Address - City:PARK RIVER
Practice Address - State:ND
Practice Address - Zip Code:58270-4540
Practice Address - Country:US
Practice Address - Phone:701-284-4682
Practice Address - Fax:701-284-4581
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist