Provider Demographics
NPI:1942036538
Name:DE HAAN, MADISON LEA (BA)
Entity type:Individual
Prefix:MS
First Name:MADISON
Middle Name:LEA
Last Name:DE HAAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E SQUIRE DR APT 2
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1835
Mailing Address - Country:US
Mailing Address - Phone:239-777-5772
Mailing Address - Fax:
Practice Address - Street 1:1320 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1622
Practice Address - Country:US
Practice Address - Phone:585-641-0281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program