Provider Demographics
NPI:1710608526
Name:HALEY, KAMILLE ARBRINTHA (LAC)
Entity Type:Individual
Prefix:DR
First Name:KAMILLE
Middle Name:ARBRINTHA
Last Name:HALEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12812 COLDWATER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9516
Mailing Address - Country:US
Mailing Address - Phone:260-445-8389
Mailing Address - Fax:888-607-1633
Practice Address - Street 1:12812 COLDWATER RD STE 101
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-9516
Practice Address - Country:US
Practice Address - Phone:260-445-8389
Practice Address - Fax:888-607-1633
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000241A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN84000241AOtherACUPUNCTURE STATE LICENSE NUMBER