Provider Demographics
NPI:1679071625
Name:HASLAG, LISA NICOLE (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:NICOLE
Last Name:HASLAG
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 MURPHY FORD RD
Mailing Address - Street 2:
Mailing Address - City:CENTERTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:65023-3504
Mailing Address - Country:US
Mailing Address - Phone:573-301-0876
Mailing Address - Fax:
Practice Address - Street 1:401 N KEENE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6625
Practice Address - Country:US
Practice Address - Phone:573-876-1644
Practice Address - Fax:573-876-1678
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018002178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily