Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 3528 | WI |
NPI | 1013166768 |
---|---|
Provider Name | Susan L Hafemann |
First Address | Greenfield, WI 53220-4800 |
Second Address | Greenfield, WI 53220-4800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2008 |
Last Update Date | 23/11/2021 |