Healthcare Provider Details

I. General information

NPI: 1013227784
Provider Name (Legal Business Name): LIZABETH D HAAS RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 EAST THIRD STREET
CHATTANOOGA TN
37403
US

IV. Provider business mailing address

106 CLAIRE STREET
ROSSVILLE GA
39741
US

V. Phone/Fax

Practice location:
  • Phone: 423-209-8332
  • Fax:
Mailing address:
  • Phone: 706-866-1969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN147639
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN142082
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: