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General NPI Number Information
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NPI Number | 1740256965
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Entity Type | Individual
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Provider Name | MINDY SUSAN HAENN PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/27/2006
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 3 COOPER PLZ SUITE 411
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City | CAMDEN
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State | NJ
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Zip | 08103-1438
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Country | US
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Telephone | 856-342-3113
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Fax | 856-968-8388
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Provider Business Mailing Address
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Address Line | 3 COOPER PLZ SUITE 403
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City | CAMDEN
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State | NJ
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Zip | 08103-1438
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Country | US
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Telephone | 856-342-3113
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Fax | 856-541-5379
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | C5-0000363
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | C5-0000363
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License Number State | DE
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MP00161700
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License Number State | NJ
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