Provider Demographics
NPI:1609478908
Name:DECERO, HALEY (NP)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:DECERO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2016
Mailing Address - Country:US
Mailing Address - Phone:708-222-7536
Mailing Address - Fax:
Practice Address - Street 1:311 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-2016
Practice Address - Country:US
Practice Address - Phone:708-222-7536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.022199363LF0000X
WI10983-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily