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TINA MARIE HAASE APNP
>> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1811571912
Individual Registrant: TINA MARIE HAASE APNP
Gender: F
Not Sole Proprietor
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
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
Tel: 920-478-2141 Fax: 920-478-3820
Registration Information:
NPI: 1811571912
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | WI | 10859 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 1811571912 | WI | 05 |
