Provider Demographics
NPI:1043498124
Name:HALEY, JANICE MARIE
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:MARIE
Last Name:HALEY
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 1:400 PALO VERDE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-6028
Mailing Address - Country:US
Mailing Address - Phone:720-799-0508
Mailing Address - Fax:702-799-0510
Practice Address - Street 1:400 PALO VERDE DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-6028
Practice Address - Country:US
Practice Address - Phone:720-799-0508
Practice Address - Fax:702-799-0510
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001011363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics