Provider Demographics
NPI:1740940295
Name:HAAS, LISA GAY
Entity type:Individual
Prefix:MR
First Name:LISA
Middle Name:GAY
Last Name:HAAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 N CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-2950
Mailing Address - Country:US
Mailing Address - Phone:920-427-8773
Mailing Address - Fax:
Practice Address - Street 1:530 N CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-2950
Practice Address - Country:US
Practice Address - Phone:920-427-8773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-26
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI81461-30163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI81461-30OtherREGISTERED NURSE LICENSE