Provider Demographics
NPI:1689688756
Name:HASKEW, MARY JANE (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:HASKEW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:502 S OLD ORCHARD LN
Mailing Address - Street 2:SUITE 126
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4374
Mailing Address - Country:US
Mailing Address - Phone:972-436-7962
Mailing Address - Fax:972-353-5780
Practice Address - Street 1:502 S OLD ORCHARD LN
Practice Address - Street 2:SUITE 126
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4374
Practice Address - Country:US
Practice Address - Phone:972-436-7962
Practice Address - Fax:972-353-5780
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX545514363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153212903Medicaid
TX545514OtherNURSE PRACTITIONERS