Provider Demographics
NPI:1801024021
Name:VAN HAASTERT, ALLISON ANN (MD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:ANN
Last Name:VAN HAASTERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 DEBARR RD STE C205
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2961
Mailing Address - Country:US
Mailing Address - Phone:907-279-2273
Mailing Address - Fax:907-258-7705
Practice Address - Street 1:2741 DEBARR RD STE C205
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2961
Practice Address - Country:US
Practice Address - Phone:907-279-2273
Practice Address - Fax:907-258-7705
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE26093207V00000X
AK130185207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1687658Medicaid