Provider Demographics
NPI:1598463523
Name:HAAG, DEVON
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:HAAG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEVON
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:85 RESERVOIR ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-1238
Mailing Address - Country:US
Mailing Address - Phone:570-854-2236
Mailing Address - Fax:
Practice Address - Street 1:85 RESERVOIR ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1238
Practice Address - Country:US
Practice Address - Phone:570-854-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker