Provider Demographics
NPI:1225647555
Name:PONTIFF, HALEY THERESA (RN, BSN, DIPACLM)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:THERESA
Last Name:PONTIFF
Suffix:
Gender:F
Credentials:RN, BSN, DIPACLM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W WILLIAM DAVID PKWY APT C
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-3360
Mailing Address - Country:US
Mailing Address - Phone:504-237-2223
Mailing Address - Fax:
Practice Address - Street 1:4921 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5664
Practice Address - Country:US
Practice Address - Phone:504-217-5319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN137442163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition Support