Provider Demographics
NPI:1417665928
Name:BASSETT, HAYLEE WILSON
Entity Type:Individual
Prefix:
First Name:HAYLEE
Middle Name:WILSON
Last Name:BASSETT
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 1:301 MILLSIDE DR APT 703
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8166
Mailing Address - Country:US
Mailing Address - Phone:478-703-7577
Mailing Address - Fax:
Practice Address - Street 1:301 MILLSIDE DR APT 703
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8166
Practice Address - Country:US
Practice Address - Phone:478-703-7577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider