Provider Demographics
NPI:1992195663
Name:HASE, KATHLEEN MARGARET (CRNA)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARGARET
Last Name:HASE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2241 4TH AVE UNIT 302
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2120
Mailing Address - Country:US
Mailing Address - Phone:717-495-6693
Mailing Address - Fax:
Practice Address - Street 1:488 E VALLEY PKWY STE 110
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3366
Practice Address - Country:US
Practice Address - Phone:717-495-6693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041426836367500000X
CA95000906367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01436514OtherRAILROAD MEDICARE
ILF400195339Medicare PIN