Healthcare Provider Details

I. General information

NPI: 1386921013
Provider Name (Legal Business Name): JAMES HASSELLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MASSACHUSETTS ST SUITE 408
LAWRENCE KS
66044-2868
US

IV. Provider business mailing address

900 MASSACHUSETTS ST SUITE 408
LAWRENCE KS
66044-2868
US

V. Phone/Fax

Practice location:
  • Phone: 785-865-2400
  • Fax: 785-865-0014
Mailing address:
  • Phone: 785-865-2400
  • Fax: 785-865-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number74031
License Number StateKS

VIII. Authorized Official

Name: JAMES E HASSELLE
Title or Position: OWNER
Credential: M.D.
Phone: 785-865-2400