Provider Demographics
NPI:1225584873
Name:HALLEY, ANGEL
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:HALLEY
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 1:707 HOUCK RD
Mailing Address - Street 2:
Mailing Address - City:PATRIOT
Mailing Address - State:OH
Mailing Address - Zip Code:45658-9088
Mailing Address - Country:US
Mailing Address - Phone:740-794-0362
Mailing Address - Fax:
Practice Address - Street 1:707 HOUCK RD
Practice Address - Street 2:
Practice Address - City:PATRIOT
Practice Address - State:OH
Practice Address - Zip Code:45658-9088
Practice Address - Country:US
Practice Address - Phone:740-794-0362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH319627163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse