1235914185 NPI number — JILLIAN DEE HASELEU LAPC

Table of content: JILLIAN DEE HASELEU LAPC (NPI 1235914185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235914185 NPI number — JILLIAN DEE HASELEU LAPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASELEU
Provider First Name:
JILLIAN
Provider Middle Name:
DEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LAPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KASOWSKI
Provider Other First Name:
JILLIAN
Provider Other Middle Name:
DEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235914185
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 3RD ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMESTOWN
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58401-2968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-253-6300
Provider Business Mailing Address Fax Number:
701-253-6400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 3RD ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58401-2968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-253-6300
Provider Business Practice Location Address Fax Number:
701-253-6400
Provider Enumeration Date:
08/29/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  1262-2-1-23A , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)