Basic Information
| Provider Information | |||||||||
| NPI: | 1366470940 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIMBLE-HAAS | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Credential: | C.N.M., CFNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2960 TONGASS AVE | ||||||||
| Address2: | |||||||||
| City: | KETCHIKAN | ||||||||
| State: | AK | ||||||||
| PostalCode: | 999015742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072284900 | ||||||||
| FaxNumber: | 8008523264 | ||||||||
| Practice Location | |||||||||
| Address1: | 2960 TONGASS AVE | ||||||||
| Address2: | |||||||||
| City: | KETCHIKAN | ||||||||
| State: | AK | ||||||||
| PostalCode: | 999015742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072284900 | ||||||||
| FaxNumber: | 8008523264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 01/19/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 607019-1 | NY | N | Nursing Service Providers | Registered Nurse | 163WG0000X | 107645 | CO | N | Nursing Service Providers | Registered Nurse | General Practice | 363LF0000X | F335771-1 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 367A00000X | F001331-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | HS19OP | 05 | AK | MEDICAID | 31005837 | 05 | NM | MEDICAID | HS19IP | 05 | AK | MEDICAID |