Provider Demographics
NPI:1114559952
Name:HYLER, HALEY M (PA)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:M
Last Name:HYLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:M
Other - Last Name:BIANCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:725 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3500
Practice Address - Country:US
Practice Address - Phone:920-431-5650
Practice Address - Fax:920-433-7400
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010253363A00000X
WI7637-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1179581OtherNATIONAL COMMISSION ON CERTIF OF PHYSICIAN ASSISTANTS