Basic Information
| Provider Information | |||||||||
| NPI: | 1659405728 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HASKETT | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | TIM | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | G.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6860 | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955026860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074433384 | ||||||||
| FaxNumber: | 7074433204 | ||||||||
| Practice Location | |||||||||
| Address1: | 4410 CHAFFIN RD | ||||||||
| Address2: | |||||||||
| City: | MCKINLEYVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955198029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078452570 | ||||||||
| FaxNumber: | 8889609819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 11/14/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 6064 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.