Individual
CODY HAAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
1047 S WELLS ST STE 106, MERIDIAN, ID 83642-7997
(208) 297-3428
(208) 297-3978
Mailing address
1047 S WELLS ST, MERIDIAN, ID 83642-7997
(208) 297-3428
(208) 297-3978
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
202201741NP-PP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
58483
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902462039
—
ID
05
—
500808652
—
OR
Enumeration date
05/14/2019
Last updated
06/06/2024
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