Provider Demographics
NPI:1023206190
Name:HAAS, MARIANNE B (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:B
Last Name:HAAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 NAVAHO AVE
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-2427
Mailing Address - Country:US
Mailing Address - Phone:228-762-0079
Mailing Address - Fax:
Practice Address - Street 1:4606 NAVAHO AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-2427
Practice Address - Country:US
Practice Address - Phone:228-762-0079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-13
Last Update Date:2007-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP317693164W00000X
AL2-051611164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse