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General NPI Number Information
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NPI Number | 1710150891
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Entity Type | Individual
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Provider Name | MARY MARGARET HASENSTAUB NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 408 9TH ST SW
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City | CANTON
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State | OH
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Zip | 44707-4714
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Country | US
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Telephone | 330-454-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 1241 E DYER RD STE 145
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City | SANTA ANA
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State | CA
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Zip | 92705-5694
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Country | US
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Telephone | 888-306-0615
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Fax | 888-353-6442
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN275132
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APRN.CMP.09872
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP09872
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License Number State | OH
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