Provider Demographics
NPI:1467032193
Name:WYCKOFF, HALEY NICOLE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:NICOLE
Last Name:WYCKOFF
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4543
Mailing Address - Country:US
Mailing Address - Phone:631-271-5800
Mailing Address - Fax:631-271-5806
Practice Address - Street 1:830 PARK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4543
Practice Address - Country:US
Practice Address - Phone:631-271-5800
Practice Address - Fax:631-271-5806
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY632131163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse