Provider Demographics
NPI:1104216407
Name:ROBERTSON, HAYLEY (RN)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7404 MACEDONIA CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:SC
Mailing Address - Zip Code:29127-9315
Mailing Address - Country:US
Mailing Address - Phone:803-622-1019
Mailing Address - Fax:
Practice Address - Street 1:7404 MACEDONIA CHURCH RD
Practice Address - Street 2:
Practice Address - City:PROSPERITY
Practice Address - State:SC
Practice Address - Zip Code:29127-9315
Practice Address - Country:US
Practice Address - Phone:803-622-1019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC204422163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse