Provider Demographics
NPI:1720359664
Name:HAARHOFF, SUSANNA A (APRN, FNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:A
Last Name:HAARHOFF
Suffix:
Gender:F
Credentials:APRN, FNP, PMHNP
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:A
Other - Last Name:HAARHOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, FNP-BC
Mailing Address - Street 1:PO BOX 4522
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-0522
Mailing Address - Country:US
Mailing Address - Phone:660-720-7110
Mailing Address - Fax:913-786-4348
Practice Address - Street 1:7050 W 107TH ST STE 10
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1921
Practice Address - Country:US
Practice Address - Phone:660-720-7110
Practice Address - Fax:913-786-4348
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5375594071363LP0808X
KS5375594363LF0000X
MO2012008579363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200971030AOtherKMAP ID
KSKA2795001OtherMEDICARE PTAN
KS01720880OtherMEDICAID AMERIGROUP ID