Healthcare Provider Details

I. General information

NPI: 1447841564
Provider Name (Legal Business Name): SARAH ANN HAACK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH ANN KADHIM RN

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 SW COAST HWY STE 203
NEWPORT OR
97365-5215
US

IV. Provider business mailing address

36 SW NYE ST
NEWPORT OR
97365-3821
US

V. Phone/Fax

Practice location:
  • Phone: 541-265-0445
  • Fax:
Mailing address:
  • Phone: 541-265-0445
  • Fax: 844-760-0526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number099007900RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: