Provider Demographics
NPI:1740656404
Name:HAASE, PERRY (RN)
Entity type:Individual
Prefix:
First Name:PERRY
Middle Name:
Last Name:HAASE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 CLEARFIELD DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2313
Mailing Address - Country:US
Mailing Address - Phone:402-238-6314
Mailing Address - Fax:402-844-8206
Practice Address - Street 1:2600 W NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4449
Practice Address - Country:US
Practice Address - Phone:402-644-7664
Practice Address - Fax:402-844-8206
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE67780163WC1500X, 163WM0705X, 163WP0200X, 163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP0200XNursing Service ProvidersRegistered NursePediatrics