Basic Information
| Provider Information | |||||||||
| NPI: | 1619942257 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAGUE | ||||||||
| FirstName: | BILLIE | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 N OAK AVE | ||||||||
| Address2: | |||||||||
| City: | MARSHFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544495703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153875511 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12961 27TH AVE | ||||||||
| Address2: | |||||||||
| City: | CHIPPEWA FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547295699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7157383700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 01/26/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0330 | SD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 3572 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 6825632 | 05 | SD | MEDICAID |