Provider Demographics
NPI:1083235568
Name:COOK, HALEIGH LANE (INDEPENDENT PROVIDER)
Entity Type:Individual
Prefix:
First Name:HALEIGH
Middle Name:LANE
Last Name:COOK
Suffix:
Gender:F
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 FRANSHIRE E
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-2484
Mailing Address - Country:US
Mailing Address - Phone:614-406-6573
Mailing Address - Fax:
Practice Address - Street 1:635 FRANSHIRE E
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-2484
Practice Address - Country:US
Practice Address - Phone:614-406-6573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0399280Medicaid