Provider Demographics
NPI:1083295273
Name:EINCK, HAILEY REBECCA (PA-C)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:REBECCA
Last Name:EINCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 E BARNETT RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8332
Mailing Address - Country:US
Mailing Address - Phone:541-201-4700
Mailing Address - Fax:541-488-5102
Practice Address - Street 1:269 MAPLE ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1551
Practice Address - Country:US
Practice Address - Phone:541-201-4700
Practice Address - Fax:541-488-5102
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR204918363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical