Provider Demographics
NPI:1245828110
Name:NIEVES, HAYLEY MARIE CECEILIA
Entity type:Individual
Prefix:
First Name:HAYLEY
Middle Name:MARIE CECEILIA
Last Name:NIEVES
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 1:603 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-3125
Mailing Address - Country:US
Mailing Address - Phone:716-489-9253
Mailing Address - Fax:
Practice Address - Street 1:10745 PA-18
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:PA
Practice Address - Zip Code:16475-0001
Practice Address - Country:US
Practice Address - Phone:814-756-5778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062262363AM0700X
NY025995363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical