Basic Information
| Provider Information | |||||||||
| NPI: | 1225655095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAAS | ||||||||
| FirstName: | MACKENZIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1453 HOPE WAY | ||||||||
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| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371293140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158939390 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3300 W END AVE APT 402 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037757688 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2020 | ||||||||
| LastUpdateDate: | 01/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 240567 | TN | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363LF0000X | 28464 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.