Provider Demographics
NPI:1649516857
Name:HALEY, SHIRLEY L (ARNP)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:L
Last Name:HALEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3330
Mailing Address - Country:US
Mailing Address - Phone:307-682-8110
Mailing Address - Fax:307-685-1193
Practice Address - Street 1:1304 WEST 4TH STREET
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716
Practice Address - Country:US
Practice Address - Phone:397-682-8110
Practice Address - Fax:307-685-1193
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10935.0155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily