Healthcare Provider Details

I. General information

NPI: 1871570689
Provider Name (Legal Business Name): NANCY HAITZ RN,CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 BATAVIA CITY CTR
BATAVIA NY
14020-2146
US

IV. Provider business mailing address

47 BATAVIA CITY CTR
BATAVIA NY
14020-2107
US

V. Phone/Fax

Practice location:
  • Phone: 585-343-2611
  • Fax: 585-343-3826
Mailing address:
  • Phone: 585-343-2611
  • Fax: 585-343-3826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberF3809181
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: