Provider Demographics
NPI:1639843311
Name:HAGGARD, NIYA (BSN, RN)
Entity Type:Individual
Prefix:
First Name:NIYA
Middle Name:
Last Name:HAGGARD
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14130 GREENBRIAR ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2740
Mailing Address - Country:US
Mailing Address - Phone:248-606-5129
Mailing Address - Fax:
Practice Address - Street 1:24230 KARIM BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2960
Practice Address - Country:US
Practice Address - Phone:248-724-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704334186163WC0400X, 163WC1500X, 163WL0100X, 163WM0102X, 163WP0808X, 163WX0003X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient