Provider Demographics
NPI:1427178318
Name:HAASE, ROSEMARIE (FNP)
Entity type:Individual
Prefix:MS
First Name:ROSEMARIE
Middle Name:
Last Name:HAASE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 ROXBURY RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1215
Mailing Address - Country:US
Mailing Address - Phone:516-877-2312
Mailing Address - Fax:
Practice Address - Street 1:310 E SHORE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2410
Practice Address - Country:US
Practice Address - Phone:516-482-8657
Practice Address - Fax:516-829-0002
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332543363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily