Provider Demographics
NPI:1174926521
Name:HAFFKE, LOUISE MARIE (RN)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:MARIE
Last Name:HAFFKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17420 FERNWAY RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-3312
Mailing Address - Country:US
Mailing Address - Phone:216-862-1462
Mailing Address - Fax:
Practice Address - Street 1:17420 FERNWAY RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-3312
Practice Address - Country:US
Practice Address - Phone:216-862-1462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.324044163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool