Healthcare Provider Details

I. General information

NPI: 1679531859
Provider Name (Legal Business Name): SARA MARGARET HASLAG CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 CORONA RD SUITE 207
COLUMBIA MO
65203-2548
US

IV. Provider business mailing address

2311 CHERRY RIDGE LN
COLUMBIA MO
65203-5724
US

V. Phone/Fax

Practice location:
  • Phone: 573-234-1000
  • Fax: 573-234-1771
Mailing address:
  • Phone: 573-234-1000
  • Fax: 573-234-1771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number094877
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: