Provider Demographics
NPI:1346767563
Name:MAHER-HASSE, KARMIN RENAE (NP)
Entity type:Individual
Prefix:
First Name:KARMIN
Middle Name:RENAE
Last Name:MAHER-HASSE
Suffix:
Gender:
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:PO BOX 190930
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-0930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1050 SW 3RD AVE STE 3200
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-4560
Practice Address - Country:US
Practice Address - Phone:208-302-0000
Practice Address - Fax:208-302-0000
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDTEMP65149363L00000X
OR10031857363L00000X
OR200242161RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse