Provider Demographics
NPI:1073705877
Name:HAAG, DOROTHY MARLENE (RN, BSN, HN-BC, CHTP)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:MARLENE
Last Name:HAAG
Suffix:
Gender:F
Credentials:RN, BSN, HN-BC, CHTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8095 GRANITE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-9530
Mailing Address - Country:US
Mailing Address - Phone:916-791-1710
Mailing Address - Fax:
Practice Address - Street 1:8095 GRANITE OAKS DR
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-9530
Practice Address - Country:US
Practice Address - Phone:916-791-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88701163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse