Basic Information
| Provider Information | |||||||||
| NPI: | 1225403041 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAAS | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | N.P. | ||||||||
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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: | 4193354600 | ||||||||
| FaxNumber: | 4193354900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2015 | ||||||||
| LastUpdateDate: | 06/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 18217-NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.