Provider Demographics
NPI:1093321408
Name:CANTWELL, HALEY LOREN
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:LOREN
Last Name:CANTWELL
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 1:6133 SHERWOOD WAY APT 6101
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-5640
Mailing Address - Country:US
Mailing Address - Phone:817-983-1385
Mailing Address - Fax:
Practice Address - Street 1:6133 SHERWOOD WAY APT 6101
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-5640
Practice Address - Country:US
Practice Address - Phone:817-983-1385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX961243163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse