Provider Demographics
NPI:1497153266
Name:HAAS, SHANE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:HAAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N CURTIS RD STE 304
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1341
Mailing Address - Country:US
Mailing Address - Phone:208-342-4263
Mailing Address - Fax:208-375-0597
Practice Address - Street 1:901 N CURTIS RD STE 304
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1341
Practice Address - Country:US
Practice Address - Phone:208-342-4263
Practice Address - Fax:208-375-0597
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant