Provider Demographics
NPI:1629684329
Name:HAAG, BLAYNE MARIE (RN)
Entity Type:Individual
Prefix:
First Name:BLAYNE
Middle Name:MARIE
Last Name:HAAG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BLAYNE
Other - Middle Name:MARIE
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3740 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-4129
Mailing Address - Country:US
Mailing Address - Phone:308-730-2653
Mailing Address - Fax:
Practice Address - Street 1:5905 O ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2235
Practice Address - Country:US
Practice Address - Phone:402-436-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE81281163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse