Provider Demographics
NPI:1427758119
Name:HAASE, ALLY (RN, BSN)
Entity type:Individual
Prefix:
First Name:ALLY
Middle Name:
Last Name:HAASE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 N 2ND ST APT 2202
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1776
Mailing Address - Country:US
Mailing Address - Phone:425-351-7043
Mailing Address - Fax:
Practice Address - Street 1:1310 N 2ND ST APT 2202
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1776
Practice Address - Country:US
Practice Address - Phone:425-351-7043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ263612163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics