Provider Demographics
NPI:1558830042
Name:BOTTRELL, HALEY LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:LYNN
Last Name:BOTTRELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2342 STONEBRIDGE DR BLDG H
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5406
Mailing Address - Country:US
Mailing Address - Phone:810-732-3812
Mailing Address - Fax:
Practice Address - Street 1:2342 STONEBRIDGE DR BLDG H
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5406
Practice Address - Country:US
Practice Address - Phone:810-732-3812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009747363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant