Provider Demographics
NPI:1891984480
Name:HAASE-MACMILLAN, URSULA A (CP)
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:A
Last Name:HAASE-MACMILLAN
Suffix:
Gender:F
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CIRO AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1671
Mailing Address - Country:US
Mailing Address - Phone:408-248-9840
Mailing Address - Fax:
Practice Address - Street 1:125 CIRO AVE STE 240
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1671
Practice Address - Country:US
Practice Address - Phone:408-248-9840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist