Healthcare Provider Details

I. General information

NPI: 1073243309
Provider Name (Legal Business Name): ANNELISE HAFT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 COOPER POINT RD SW
OLYMPIA WA
98502-5736
US

IV. Provider business mailing address

1620 COOPER POINT RD SW
OLYMPIA WA
98502-5736
US

V. Phone/Fax

Practice location:
  • Phone: 360-486-6710
  • Fax: 360-705-0269
Mailing address:
  • Phone: 360-486-6710
  • Fax: 360-705-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61333156
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: