Provider Demographics
NPI:1003423898
Name:LUU, HALEY MAI-TRAM
Entity Type:Individual
Prefix:MS
First Name:HALEY
Middle Name:MAI-TRAM
Last Name:LUU
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 1:44831 MILESTONE SQ APT 336
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4225
Mailing Address - Country:US
Mailing Address - Phone:540-313-0822
Mailing Address - Fax:
Practice Address - Street 1:1300 EDWARDS FERRY RD NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3355
Practice Address - Country:US
Practice Address - Phone:540-313-0822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230030285183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0230030285OtherVIRGINIA DEPARTMENT OF HEALTH PROFESSIONS