Provider Demographics
NPI:1447361472
Name:HAASE, TONYA LYNN (RN, CNP)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:LYNN
Last Name:HAASE
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8746 GRIER LN
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-6633
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3400 W 66TH ST STE 290
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2133
Practice Address - Country:US
Practice Address - Phone:952-914-0883
Practice Address - Fax:952-948-7416
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2886162-00Medicaid
MN500002751Medicare ID - Type Unspecified
MNQ27036Medicare UPIN