Provider Demographics
NPI:1740706662
Name:FISH, HALEY JUSTINE (FNP)
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:JUSTINE
Last Name:FISH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:HALEY
Other - Middle Name:JUSTINE
Other - Last Name:BIRKMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:13293 STATE ROUTE 38
Mailing Address - Street 2:
Mailing Address - City:RICHFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13835
Mailing Address - Country:US
Mailing Address - Phone:607-657-8521
Mailing Address - Fax:607-657-8006
Practice Address - Street 1:13293 STATE ROUTE 38
Practice Address - Street 2:
Practice Address - City:RICHFORD
Practice Address - State:NY
Practice Address - Zip Code:13835
Practice Address - Country:US
Practice Address - Phone:607-657-8521
Practice Address - Fax:607-657-8006
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF342058-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily