Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 350429 | NY |
NPI | 1376068916 |
---|---|
Provider Name | Mrs. Jennifer D Haas |
First Address | Stony Brook, NY 11794-0001 |
Second Address | Stony Brook, NY 11794-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2017 |
Last Update Date | 04/08/2017 |