Provider Demographics
NPI:1619732278
Name:JUSTL, HAILEY (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:JUSTL
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 W DUNBAR DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-6771
Mailing Address - Country:US
Mailing Address - Phone:623-670-0071
Mailing Address - Fax:
Practice Address - Street 1:13802 N 32ND ST STE 8
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5638
Practice Address - Country:US
Practice Address - Phone:623-670-0071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL-312536163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant