Healthcare Provider Details

I. General information

NPI: 1992195663
Provider Name (Legal Business Name): KATHLEEN MARGARET HASE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 01/07/2022
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 E VALLEY PKWY STE 110
ESCONDIDO CA
92025-3366
US

IV. Provider business mailing address

2241 4TH AVE UNIT 302
SAN DIEGO CA
92101-2120
US

V. Phone/Fax

Practice location:
  • Phone: 717-495-6693
  • Fax:
Mailing address:
  • Phone: 717-495-6693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041426836
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: