Organization Name: | MICHELLE HAAS |
NPI Number: | 1073984993 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LAUREN M HEFNER (BILLING MANAGER) |
Mailing Address: | 1190 N Shoop Ave Wauseon |
State: | OH US |
Postal Code: | 435672224 |
Phone Number: | 4193354601 |
Fax Number: | 4193354900 |
NPI Enumeration Date: | 10/19/2015 |
NPI Last Update Date: | 11/30/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 18217 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |