Healthcare Provider Details

I. General information

NPI: 1295968030
Provider Name (Legal Business Name): MICHELE RAE HASZ BA, MTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 W LONG ST
COLUMBUS OH
43215-2815
US

IV. Provider business mailing address

16 W LONG ST
COLUMBUS OH
43215-2815
US

V. Phone/Fax

Practice location:
  • Phone: 614-225-0990
  • Fax:
Mailing address:
  • Phone: 614-225-0990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number399357
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: