Provider Demographics
NPI:1154303543
Name:HASS, VIRGINIA MCCOY (FNP, DNP)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:MCCOY
Last Name:HASS
Suffix:
Gender:F
Credentials:FNP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2516 STOCKTON BLVD
Mailing Address - Street 2:STE 254
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2208
Mailing Address - Country:US
Mailing Address - Phone:916-734-1497
Mailing Address - Fax:916-452-2112
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:STE. 1600
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-3630
Practice Address - Fax:916-734-5550
Is Sole Proprietor?:No
Enumeration Date:2005-11-19
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN352214363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS71815Medicare UPIN
ZZZ15751ZMedicare PIN