Provider Demographics
NPI:1023281821
Name:HAAG, ROGER O (LPN)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:O
Last Name:HAAG
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DELTA AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NY
Mailing Address - Zip Code:13076-3116
Mailing Address - Country:US
Mailing Address - Phone:315-668-3935
Mailing Address - Fax:
Practice Address - Street 1:24 DELTA AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NY
Practice Address - Zip Code:13076-3116
Practice Address - Country:US
Practice Address - Phone:315-668-3935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-12
Last Update Date:2008-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129115164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse