Provider Demographics
NPI:1770096414
Name:LONG, HALEY JEAN (PAC)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:JEAN
Last Name:LONG
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:18653 WEDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-3323
Mailing Address - Country:US
Mailing Address - Phone:775-770-7210
Mailing Address - Fax:775-770-7211
Practice Address - Street 1:18653 WEDGE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-3038
Practice Address - Country:US
Practice Address - Phone:775-770-7210
Practice Address - Fax:775-770-7211
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVPA1945363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant