Provider Demographics
NPI:1699867242
Name:HAASE, LINDA SUSAN (FNP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:SUSAN
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 1:2617 E CHAPMAN AVE
Mailing Address - Street 2:#306
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869
Mailing Address - Country:US
Mailing Address - Phone:714-998-9512
Mailing Address - Fax:914-744-9864
Practice Address - Street 1:2617 E CHAPMAN AVE
Practice Address - Street 2:#306
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869
Practice Address - Country:US
Practice Address - Phone:714-997-1920
Practice Address - Fax:914-744-9864
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF9632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine