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General NPI Number Information
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NPI Number | 1548343668
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Entity Type | Individual
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Provider Name | KATHLEEN A HAAS PNP
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Gender | Female
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 3925 OLD REDWOOD HWY
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City | SANTA ROSA
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State | CA
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Zip | 95403-1719
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Country | US
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Telephone | 707-566-5326
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Fax |
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Provider Business Mailing Address
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Address Line | 4327 FISTOR DR
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City | SANTA ROSA
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State | CA
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Zip | 95409-2616
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Country | US
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Telephone | 707-538-2687
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 493456
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License Number State | CA
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