Provider Demographics
NPI:1477976363
Name:CRITES, HALEY (PA-C)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:CRITES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:52375 N MAIN ST
Mailing Address - Street 2:BOX 89
Mailing Address - City:MATTAWAN
Mailing Address - State:MI
Mailing Address - Zip Code:49071-9332
Mailing Address - Country:US
Mailing Address - Phone:269-668-3348
Mailing Address - Fax:269-668-7702
Practice Address - Street 1:52375 N MAIN ST
Practice Address - Street 2:BOX 89
Practice Address - City:MATTAWAN
Practice Address - State:MI
Practice Address - Zip Code:49071-9332
Practice Address - Country:US
Practice Address - Phone:269-668-3348
Practice Address - Fax:269-668-7702
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2015-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601006912363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical