Provider Demographics
NPI:1235697277
Name:HAAGA, STACIE SEABORN (RD)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:SEABORN
Last Name:HAAGA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 HORSESHOE CT
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-2891
Mailing Address - Country:US
Mailing Address - Phone:540-751-8629
Mailing Address - Fax:
Practice Address - Street 1:177 HORSESHOE CT
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-2891
Practice Address - Country:US
Practice Address - Phone:540-751-8629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
940354133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered