Provider Demographics
NPI:1538486980
Name:BLACK, HALEY S (RN)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:S
Last Name:BLACK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6354 COWGILL LN
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43732-9403
Mailing Address - Country:US
Mailing Address - Phone:740-638-2709
Mailing Address - Fax:
Practice Address - Street 1:6354 COWGILL LN
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:OH
Practice Address - Zip Code:43732-9403
Practice Address - Country:US
Practice Address - Phone:740-638-2709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN227735163WH0200X, 376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No376G00000XNursing Service Related ProvidersNursing Home Administrator