Provider Demographics
NPI:1518613868
Name:GOMEZ, HALEY MICHELLE
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:MICHELLE
Last Name:GOMEZ
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 1:18829 MILLS BAY DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8565
Mailing Address - Country:US
Mailing Address - Phone:909-803-7319
Mailing Address - Fax:
Practice Address - Street 1:2741 DEBARR RD STE C205
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2961
Practice Address - Country:US
Practice Address - Phone:907-279-2273
Practice Address - Fax:907-258-7705
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95123191163W00000X
NJ26NR20461000163W00000X
AK179637163W00000X
AK205734363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse