Provider Demographics
NPI:1972260503
Name:HAEGE, MICHELE RAE (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:RAE
Last Name:HAEGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 PLUM ST
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:IA
Mailing Address - Zip Code:52333-9514
Mailing Address - Country:US
Mailing Address - Phone:612-999-5431
Mailing Address - Fax:
Practice Address - Street 1:804 PLUM ST
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:IA
Practice Address - Zip Code:52333-9514
Practice Address - Country:US
Practice Address - Phone:612-999-5431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA108795363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical