Provider Demographics
NPI:1689375727
Name:MADER, HALEY RAE
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:RAE
Last Name:MADER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:RAE
Other - Last Name:JAHNKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 S 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:51246-2020
Mailing Address - Country:US
Mailing Address - Phone:712-472-5400
Mailing Address - Fax:
Practice Address - Street 1:1100 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:ROCK RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:51246-2020
Practice Address - Country:US
Practice Address - Phone:712-472-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA129648363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant