Provider Demographics
NPI:1790372993
Name:HAASE, JULIA M
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:M
Last Name:HAASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4773 COUNTY ROAD 22
Mailing Address - Street 2:
Mailing Address - City:ARCHBOLD
Mailing Address - State:OH
Mailing Address - Zip Code:43502-9792
Mailing Address - Country:US
Mailing Address - Phone:419-551-1008
Mailing Address - Fax:
Practice Address - Street 1:4773 CO RD 22
Practice Address - Street 2:
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502-9792
Practice Address - Country:US
Practice Address - Phone:419-551-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care