Provider Demographics
NPI:1952520223
Name:HAAS, TERESA ALANE (LPN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ALANE
Last Name:HAAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 735
Mailing Address - Street 2:3612 SABRE DRIVE
Mailing Address - City:LAPORTE
Mailing Address - State:CO
Mailing Address - Zip Code:80535-0735
Mailing Address - Country:US
Mailing Address - Phone:970-224-3565
Mailing Address - Fax:
Practice Address - Street 1:COLORADO STATE UNIVERSITY
Practice Address - Street 2:HARTSHORN HEALTH SERVICE
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80523-8031
Practice Address - Country:US
Practice Address - Phone:970-491-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23672261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service