Provider Demographics
NPI:1811547409
Name:FRIEDEMAN, HALLEY MARIE (NP)
Entity Type:Individual
Prefix:
First Name:HALLEY
Middle Name:MARIE
Last Name:FRIEDEMAN
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:P.O BOX 358
Mailing Address - Street 2:HWY JUNCTION 57, RT9 CROWNPOINT, NM 87313
Mailing Address - City:CROWNPOINT
Mailing Address - State:NM
Mailing Address - Zip Code:87313
Mailing Address - Country:US
Mailing Address - Phone:505-786-5291
Mailing Address - Fax:505-786-6435
Practice Address - Street 1:HWY JUNCTION 57, RT9
Practice Address - Street 2:
Practice Address - City:CROWNPOINT
Practice Address - State:NM
Practice Address - Zip Code:87313
Practice Address - Country:US
Practice Address - Phone:505-786-5291
Practice Address - Fax:505-786-6435
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ226005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily