Provider Demographics
NPI:1992469654
Name:HAAG, NICOLE DOWNEY (FNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DOWNEY
Last Name:HAAG
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 1:11100 CRANBECK TER
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3577
Mailing Address - Country:US
Mailing Address - Phone:540-820-3504
Mailing Address - Fax:
Practice Address - Street 1:833 BUFFALO ST STE 200
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1111
Practice Address - Country:US
Practice Address - Phone:434-392-8177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001287772163W00000X
VA0024188362363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse