Provider Demographics
NPI:1174868111
Name:PARKER, HALEY MARCENE (DOM)
Entity Type:Individual
Prefix:DR
First Name:HALEY
Middle Name:MARCENE
Last Name:PARKER
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 SAWMILL RD APT 1321
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5691
Mailing Address - Country:US
Mailing Address - Phone:202-412-1614
Mailing Address - Fax:
Practice Address - Street 1:1505 LLANO ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2003
Practice Address - Country:US
Practice Address - Phone:505-984-3034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1092171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist