Healthcare Provider Details

I. General information

NPI: 1619283835
Provider Name (Legal Business Name): MISS SARAH KATHERINE HAAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 05/25/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 N POPE ST
SILVER CITY NM
88061-5161
US

IV. Provider business mailing address

530 DEMOSS STREET
LORDSBURG NM
88045-7287
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-1511
  • Fax: 575-313-8236
Mailing address:
  • Phone: 575-597-2738
  • Fax: 855-653-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number56564
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704277104
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-56564
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704277104
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: