Provider Demographics
NPI:1346014990
Name:LI, HAILEE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:HAILEE
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:HAILEE
Other - Middle Name:
Other - Last Name:JANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2657 E 3700 N
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-0146
Mailing Address - Country:US
Mailing Address - Phone:208-490-1501
Mailing Address - Fax:
Practice Address - Street 1:2657 E 3700 N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-0146
Practice Address - Country:US
Practice Address - Phone:208-490-1501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID60580363LF0000X, 163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0200XNursing Service ProvidersRegistered NurseOncology