Healthcare Provider Details

I. General information

NPI: 1225403041
Provider Name (Legal Business Name): MICHELLE G HAAS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 N SHOOP AVE
WAUSEON OH
43567-2224
US

IV. Provider business mailing address

PO BOX 351328
TOLEDO OH
43635-1328
US

V. Phone/Fax

Practice location:
  • Phone: 419-335-4600
  • Fax: 419-335-4900
Mailing address:
  • Phone: 419-335-4600
  • Fax: 419-335-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18217-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: