Provider Demographics
NPI:1235522020
Name:HASL, AMANDA JANEL (AG-ACNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANEL
Last Name:HASL
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6813 N 10TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1021
Mailing Address - Country:US
Mailing Address - Phone:480-516-1927
Mailing Address - Fax:
Practice Address - Street 1:13634 N 93RD AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4914
Practice Address - Country:US
Practice Address - Phone:623-815-2484
Practice Address - Fax:623-815-2483
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7640363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care