Provider Demographics
NPI:1871978627
Name:HAARER, NINA DEGIDIO (LMT, MMP)
Entity type:Individual
Prefix:MRS
First Name:NINA
Middle Name:DEGIDIO
Last Name:HAARER
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 N 15TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3289
Mailing Address - Country:US
Mailing Address - Phone:406-595-2234
Mailing Address - Fax:
Practice Address - Street 1:1276 N 15TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3289
Practice Address - Country:US
Practice Address - Phone:406-595-2234
Practice Address - Fax:406-577-2285
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1173225400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist