Basic Information
Provider Information | |||||||||
NPI: | 1750027264 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HAAS | ||||||||
FirstName: | LORI | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LPN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 949 S DUPONT BLVD | ||||||||
Address2: |   | ||||||||
City: | SMYRNA | ||||||||
State: | DE | ||||||||
PostalCode: | 199771749 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3026531600 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 15 READS WAY | ||||||||
Address2: |   | ||||||||
City: | NEW CASTLE | ||||||||
State: | DE | ||||||||
PostalCode: | 197201600 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3023222300 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/08/2022 | ||||||||
LastUpdateDate: | 05/08/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/08/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | L2-0013810 | DE | Y |   | Nursing Service Providers | Licensed Practical Nurse |   |
No ID Information.