Provider Demographics
NPI:1447983457
Name:HAACK, MARCLEANA RAE (APN)
Entity type:Individual
Prefix:
First Name:MARCLEANA
Middle Name:RAE
Last Name:HAACK
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26653 SHERINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-2688
Mailing Address - Country:US
Mailing Address - Phone:419-376-6917
Mailing Address - Fax:
Practice Address - Street 1:1039 HASKINS RD UNIT A
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-9066
Practice Address - Country:US
Practice Address - Phone:419-352-1121
Practice Address - Fax:419-352-1179
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031699363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN.390464OtherOHIO BOARD OF NURSING
F06221644OtherAANP
OHAPRN.CNP.0031699OtherOHIO BOARD OF NURSING