Provider Demographics
NPI:1255682043
Name:HAAS, NICOLE LYNNE (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNNE
Last Name:HAAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LYNNE
Other - Last Name:WEBSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3212 WILMINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105
Mailing Address - Country:US
Mailing Address - Phone:724-598-2280
Mailing Address - Fax:724-598-2282
Practice Address - Street 1:3212 WILMINGTON ROAD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105
Practice Address - Country:US
Practice Address - Phone:724-598-2280
Practice Address - Fax:724-598-2282
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055758363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1093733933OtherGROUP NPI