Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | RN028202 | AZ |
NPI | 1215179858 |
---|---|
Provider Name | Patricia Anne Haasis |
First Address | Mesa, AZ 85201-2729 |
Second Address | Gilbert, AZ 85234-1604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2009 |
Last Update Date | 16/10/2010 |