Provider Demographics
NPI:1700254257
Name:HAGGART, DESIREE (ARNP)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:HAGGART
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:
Other - Last Name:HAGGART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2145 SNOWBERRY RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-5186
Mailing Address - Country:US
Mailing Address - Phone:503-519-6925
Mailing Address - Fax:
Practice Address - Street 1:406 SE 131ST ST.
Practice Address - Street 2:SUITE A101
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684
Practice Address - Country:US
Practice Address - Phone:360-253-2822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA158408363L00000X
WARN60520891163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner