Provider Demographics
NPI:1346221983
Name:HAAS-RUEDA, VONDA (PA)
Entity Type:Individual
Prefix:
First Name:VONDA
Middle Name:
Last Name:HAAS-RUEDA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 ELM ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1217
Mailing Address - Country:US
Mailing Address - Phone:603-623-3343
Mailing Address - Fax:603-623-7924
Practice Address - Street 1:1650 ELM ST
Practice Address - Street 2:SUITE 301
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1217
Practice Address - Country:US
Practice Address - Phone:603-623-3343
Practice Address - Fax:603-623-7924
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0374363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHAP1748Medicare ID - Type Unspecified
P63755Medicare UPIN