Provider Demographics
NPI:1124097175
Name:HASKELL, ROBERTA M (NP)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:M
Last Name:HASKELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70-71 N PARISH RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-2914
Mailing Address - Country:US
Mailing Address - Phone:978-722-8391
Mailing Address - Fax:978-681-5209
Practice Address - Street 1:70-71 N PARISH RD
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-2914
Practice Address - Country:US
Practice Address - Phone:978-722-8391
Practice Address - Fax:978-681-5209
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155803363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP3417OtherBCBS
MANP3417OtherBCBS