Provider Demographics
NPI:1376255125
Name:BEMIS, HALEY (RN, BSN)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:BEMIS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1043
Mailing Address - Country:US
Mailing Address - Phone:801-525-4958
Mailing Address - Fax:
Practice Address - Street 1:22 S STATE ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1043
Practice Address - Country:US
Practice Address - Phone:801-525-4958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11269969-3102163WC1500X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health