Basic Information
| Provider Information | |||||||||
| NPI: | 1396100293 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HASS | ||||||||
| FirstName: | MARY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 799 LONG ST | ||||||||
| Address2: | |||||||||
| City: | SWEET HOME | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973863304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413673888 | ||||||||
| FaxNumber: | 5413672407 | ||||||||
| Practice Location | |||||||||
| Address1: | 530 NW 27TH ST | ||||||||
| Address2: | |||||||||
| City: | CORVALLIS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973305223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417666835 | ||||||||
| FaxNumber: | 5417666186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2015 | ||||||||
| LastUpdateDate: | 12/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3747A0650X | Y | Nursing Service Related Providers | Technician | Attendant Care Provider |
No ID Information.