Provider Demographics
NPI:1922550821
Name:HAALAND, CARLY JANE-HUSTREI (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:JANE-HUSTREI
Last Name:HAALAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:BURKLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3814 AUBURN BLVD STE 72
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2123
Mailing Address - Country:US
Mailing Address - Phone:916-426-1902
Mailing Address - Fax:916-647-0156
Practice Address - Street 1:3814 AUBURN BLVD STE 72
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2123
Practice Address - Country:US
Practice Address - Phone:916-426-1902
Practice Address - Fax:916-647-0156
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA53947363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant