Healthcare Provider Details

I. General information

NPI: 1982764379
Provider Name (Legal Business Name): LISA JEANETTE HAAS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 03/28/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 S. MAIN STREET
WALNUT CREEK CA
94596
US

IV. Provider business mailing address

1394 DANVILLE BLVD 106
ALAMO CA
94507-1965
US

V. Phone/Fax

Practice location:
  • Phone: 925-295-5305
  • Fax:
Mailing address:
  • Phone: 925-743-1782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN396890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: