Provider Demographics
NPI:1780325589
Name:SMITH, HALEY MICHELLE (MSN, FAMM)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, FAMM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 SE 16TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2671
Mailing Address - Country:US
Mailing Address - Phone:269-921-4506
Mailing Address - Fax:
Practice Address - Street 1:942 SE 16TH AVE APT 3
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2671
Practice Address - Country:US
Practice Address - Phone:269-921-4506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty