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General NPI Number Information
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NPI Number | 1184210429
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Entity Type | Individual
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Provider Name | SARAH HAASE
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Gender | Female
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Dates
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Enumeration Date | 12/20/2020
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 1740 W TAYLOR ST
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City | CHICAGO
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State | IL
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Zip | 60612-7232
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Country | US
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Telephone | 312-996-0376
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Fax |
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Provider Business Mailing Address
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Address Line | 16600 LESCOT TER
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City | ROCKVILLE
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State | MD
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Zip | 20853-1247
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Country | US
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Telephone | 301-785-9797
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085008359
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License Number State | IL
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