Basic Information
| Provider Information | |||||||||
| NPI: | 1073984993 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHELLE HAAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 351328 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436351328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193354600 | ||||||||
| FaxNumber: | 4193354900 | ||||||||
| Practice Location | |||||||||
| Address1: | 1190 N SHOOP AVE | ||||||||
| Address2: | |||||||||
| City: | WAUSEON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435672224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193354601 | ||||||||
| FaxNumber: | 4193354900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2015 | ||||||||
| LastUpdateDate: | 11/30/2015 | ||||||||
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| AuthorizedOfficialLastName: | HEFNER | ||||||||
| AuthorizedOfficialFirstName: | LAUREN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4198667162 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 18217 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.