Provider Demographics
NPI:1942935440
Name:LYMAN, HALEY MARIE (NP)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:MARIE
Last Name:LYMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:MARIE
Other - Last Name:POOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 HASTINGS ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5011
Mailing Address - Country:US
Mailing Address - Phone:909-557-4782
Mailing Address - Fax:
Practice Address - Street 1:3110 INLAND EMPIRE BLVD STE C
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-6572
Practice Address - Country:US
Practice Address - Phone:909-581-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020995363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily