Healthcare Provider Details

I. General information

NPI: 1851793871
Provider Name (Legal Business Name): TRACEY MARIE HASSER ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEW HOSP PLZ
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

1435 SAWYERS TRAIL CT
FENTON MO
63026-7047
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-1831
  • Fax:
Mailing address:
  • Phone: 314-605-6974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2013037715
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: