Healthcare Provider Details

I. General information

NPI: 1164957023
Provider Name (Legal Business Name): RACHEL HAASE DONAHUE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1896 LORCA DR APT 93
SANTA FE NM
87505-6010
US

IV. Provider business mailing address

1896 LORCA DR APT 93
SANTA FE NM
87505-6010
US

V. Phone/Fax

Practice location:
  • Phone: 480-206-7691
  • Fax:
Mailing address:
  • Phone: 480-206-7691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA-01497
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: