Provider Demographics
NPI:1174827307
Name:HALEY, ERIN JO (RDH, MS, PHRDH)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:JO
Last Name:HALEY
Suffix:
Gender:F
Credentials:RDH, MS, PHRDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 S 75TH ST
Mailing Address - Street 2:LINCOLN
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-3001
Mailing Address - Country:US
Mailing Address - Phone:402-440-7076
Mailing Address - Fax:
Practice Address - Street 1:2324 S 75TH ST
Practice Address - Street 2:LINCOLN
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-3001
Practice Address - Country:US
Practice Address - Phone:402-440-7076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE51124Q00000X
NE1252124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist