Healthcare Provider Details

I. General information

NPI: 1952943144
Provider Name (Legal Business Name): COURTNEY HAAS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2117 BENTLEY PLZ
FENTON MO
63026-2124
US

IV. Provider business mailing address

2117 BENTLEY PLZ
FENTON MO
63026-2124
US

V. Phone/Fax

Practice location:
  • Phone: 636-825-2200
  • Fax: 636-825-2201
Mailing address:
  • Phone: 636-825-2200
  • Fax: 636-825-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2019037883
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: