Provider Demographics
NPI:1477256816
Name:WASTI, HAILEY NICOLE
Entity Type:Individual
Prefix:MISS
First Name:HAILEY
Middle Name:NICOLE
Last Name:WASTI
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 1:12090 101ST AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-3242
Mailing Address - Country:US
Mailing Address - Phone:763-657-9949
Mailing Address - Fax:
Practice Address - Street 1:12090 101ST AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-3242
Practice Address - Country:US
Practice Address - Phone:763-657-9949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program