Provider Demographics
NPI:1679531859
Name:HASLAG, SARA MARGARET (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:MARGARET
Last Name:HASLAG
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2311 CHERRY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5724
Mailing Address - Country:US
Mailing Address - Phone:573-234-1000
Mailing Address - Fax:573-234-1771
Practice Address - Street 1:2011 CORONA RD
Practice Address - Street 2:SUITE 207
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2548
Practice Address - Country:US
Practice Address - Phone:573-234-1000
Practice Address - Fax:573-234-1771
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO094877363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425733912Medicaid
MO425733912Medicaid
269C103Medicare ID - Type Unspecified