Provider Demographics
NPI:1134188766
Name:HASS, ELIZABETH ANNE (PNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:HASS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:HAVERBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:17705 HUTCHINS DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-4145
Mailing Address - Country:US
Mailing Address - Phone:952-401-8300
Mailing Address - Fax:
Practice Address - Street 1:17705 HUTCHINS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-4145
Practice Address - Country:US
Practice Address - Phone:952-401-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1234998363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCP9041027731OtherPREFERED ONE
MN1209022OtherMEDICA
MN141084OtherUCARE
MN039J4HAOtherBCBS
MN141084OtherUCARE