Provider Demographics
NPI:1730177536
Name:HAUG, HEATHER MAE (PA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MAE
Last Name:HAUG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MAE
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:UNIVERSITY OF IOWA HOSPITALS & CLINICS
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-629-4214
Mailing Address - Fax:319-629-4619
Practice Address - Street 1:109 W JAYNE ST
Practice Address - Street 2:UIHC LONE TREE FAMILY PRACTICE
Practice Address - City:LONE TREE
Practice Address - State:IA
Practice Address - Zip Code:52755-0417
Practice Address - Country:US
Practice Address - Phone:319-629-4214
Practice Address - Fax:319-629-4619
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1393363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA43592OtherWELLMARK BCBS
IA44296OtherWELLMARK BCBS
IAI5552Medicare ID - Type Unspecified
IA43592OtherWELLMARK BCBS
IA44296OtherWELLMARK BCBS