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TINA MARIE HAASE APNP

>> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1811571912

Individual Registrant:
 TINA MARIE HAASE APNP
Gender: F
Not Sole Proprietor

Location and contact information for practice:
105 HIGHLAND TER  WATERLOO, WI 53594-2217 US
Tel: 920-478-2141  Fax: 920-478-3820

Contact information for business:
105 HIGHLAND TER  WATERLOO, WI 53594-2217 US
Tel: 920-478-2141  Fax: 920-478-3820

Registration Information:
NPI: 1811571912
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363L00000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
WI10859

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
1811571912WI05




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