Provider Demographics
NPI:1508464686
Name:HAAK, ELIZABETH OAKLEY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:OAKLEY
Last Name:HAAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:OAKLEY
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1322 KLABZUBA AVE
Mailing Address - Street 2:
Mailing Address - City:PRAGUE
Mailing Address - State:OK
Mailing Address - Zip Code:74864-4900
Mailing Address - Country:US
Mailing Address - Phone:405-567-4922
Mailing Address - Fax:
Practice Address - Street 1:1322 KLABZUBA AVE
Practice Address - Street 2:
Practice Address - City:PRAGUE
Practice Address - State:OK
Practice Address - Zip Code:74864-4900
Practice Address - Country:US
Practice Address - Phone:405-567-4922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3213363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant