MEDICARE: CHRISTY K HAACK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	00975	IA

General Provider Information

NPI Number	:	1265545420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY K HAACK PA-C

Provider Business Mailing Address
First Line	:	2425 WESTOWN PKWY
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1425
Country	:	US
Telephone Number	:	515-222-8346
Fax Number	:	515-222-0472

Provider Business Practice Location Address
First Line	:	2425 WESTOWN PKWY
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1425
Country	:	US
Telephone Number	:	515-222-8346
Fax Number	:	515-222-0472

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	10/19/2021

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