Provider Demographics
NPI:1033128095
Name:HALE, MARILYN H (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:H
Last Name:HALE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-4120
Mailing Address - Country:US
Mailing Address - Phone:716-373-2238
Mailing Address - Fax:716-373-2273
Practice Address - Street 1:MAPLE AVE & 5TH ST
Practice Address - Street 2:
Practice Address - City:ALLEGANY
Practice Address - State:NY
Practice Address - Zip Code:14706
Practice Address - Country:US
Practice Address - Phone:716-373-2238
Practice Address - Fax:716-373-2273
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMH0380650OtherDEA REGISTRATION NUMBER
NYMH0380650OtherDEA REGISTRATION NUMBER