Provider Demographics
NPI:1972865616
Name:HALEY, BREANNA LANE
Entity Type:Individual
Prefix:MS
First Name:BREANNA
Middle Name:LANE
Last Name:HALEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W 40TH ST
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-2644
Mailing Address - Country:US
Mailing Address - Phone:918-284-6824
Mailing Address - Fax:
Practice Address - Street 1:303 W 40TH ST
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-2644
Practice Address - Country:US
Practice Address - Phone:918-284-6824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator