Provider Demographics
NPI:1124522438
Name:HASS, JACQUELINE A (PA-C)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:A
Last Name:HASS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:A
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5255 MEMBERS PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-8381
Mailing Address - Country:US
Mailing Address - Phone:507-218-3701
Mailing Address - Fax:651-209-0514
Practice Address - Street 1:5255 MEMBERS PKWY NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-8381
Practice Address - Country:US
Practice Address - Phone:507-218-3701
Practice Address - Fax:651-209-0514
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA089709363A00000X
MN13370363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant