Provider Demographics
NPI:1558014696
Name:HAISLEY, LAURA RENEE (FNP)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:RENEE
Last Name:HAISLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8716 RAY CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-6300
Mailing Address - Country:US
Mailing Address - Phone:765-748-3924
Mailing Address - Fax:
Practice Address - Street 1:1545 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2306
Practice Address - Country:US
Practice Address - Phone:317-923-1491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-29
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28205531A363LF0000X
IN71012242A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN264430I03OtherMEDICARE PTAN