Provider Demographics
NPI:1366732307
Name:HASS, BROOKE MARIE (SVN)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:MARIE
Last Name:HASS
Suffix:
Gender:F
Credentials:SVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1752
Mailing Address - Country:US
Mailing Address - Phone:715-210-5402
Mailing Address - Fax:
Practice Address - Street 1:409 N 5TH ST
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1752
Practice Address - Country:US
Practice Address - Phone:715-210-5402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program