Provider Demographics
NPI:1679186621
Name:BRKIC, HALEY ALISSA (MSAT)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:ALISSA
Last Name:BRKIC
Suffix:
Gender:F
Credentials:MSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 W HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-5133
Mailing Address - Country:US
Mailing Address - Phone:906-362-3143
Mailing Address - Fax:
Practice Address - Street 1:334 W HAMPTON ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-5133
Practice Address - Country:US
Practice Address - Phone:906-362-3143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program