Provider Demographics
NPI:1285202754
Name:ELDRIDGE, HAILEY H
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:H
Last Name:ELDRIDGE
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 1:4304 S RAFE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-5381
Mailing Address - Country:US
Mailing Address - Phone:928-278-7515
Mailing Address - Fax:
Practice Address - Street 1:4304 S RAFE AVE
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-5381
Practice Address - Country:US
Practice Address - Phone:928-278-7515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program