Provider Demographics
NPI:1679700819
Name:HAASE, PATRICIA M (CRNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:HAASE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4826 DREXELBROOK DR
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-5305
Mailing Address - Country:US
Mailing Address - Phone:610-626-8350
Mailing Address - Fax:610-626-8714
Practice Address - Street 1:3030 GARRETT RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-2217
Practice Address - Country:US
Practice Address - Phone:610-626-0940
Practice Address - Fax:610-626-7140
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP010325363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health