Provider Demographics
NPI:1235789322
Name:FONDREN, HALLEY MARIE (APRN; FNP)
Entity Type:Individual
Prefix:MRS
First Name:HALLEY
Middle Name:MARIE
Last Name:FONDREN
Suffix:
Gender:F
Credentials:APRN; FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2634
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-2634
Mailing Address - Country:US
Mailing Address - Phone:802-673-2215
Mailing Address - Fax:
Practice Address - Street 1:PAGE STREET
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-2634
Practice Address - Country:US
Practice Address - Phone:802-673-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK146799363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily