Provider Demographics
NPI:1225105471
Name:HASLETT, THERESA MARIE (DO, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:MARIE
Last Name:HASLETT
Suffix:
Gender:F
Credentials:DO, PHARMD
Other - Prefix:DR
Other - First Name:THERESA
Other - Middle Name:MARIE
Other - Last Name:ESSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO, PHARMD
Mailing Address - Street 1:CMR 467 BOX 1493
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09096-1015
Mailing Address - Country:US
Mailing Address - Phone:01149611-705-4329
Mailing Address - Fax:
Practice Address - Street 1:CMR 467 BOX 1493
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09096-1015
Practice Address - Country:US
Practice Address - Phone:01149611-705-4329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS813207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine