Healthcare Provider Details

I. General information

NPI: 1619086238
Provider Name (Legal Business Name): DEBRA ANN HAAG CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 CHESTNUT ST
LEBANON PA
17042-2518
US

IV. Provider business mailing address

441 STRACKS DAM RD
MYERSTOWN PA
17067-2165
US

V. Phone/Fax

Practice location:
  • Phone: 717-273-8000
  • Fax: 717-273-8244
Mailing address:
  • Phone: 717-866-4934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP007130
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN240778L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: