Healthcare Provider Details

I. General information

NPI: 1720563497
Provider Name (Legal Business Name): COLLEEN PATRICIA HAESCHE PCW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RURAL CLINICS FERNLEY 415 HIGHWAY 95A BUILDING I
FERNLEY NV
89408-9261
US

IV. Provider business mailing address

727 FAIRVIEW DR. STE A
CARSON CITY NV
89701-5493
US

V. Phone/Fax

Practice location:
  • Phone: 775-575-7744
  • Fax: 775-575-7769
Mailing address:
  • Phone: 775-684-5000
  • Fax: 775-687-1181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: