Provider Demographics
NPI:1801562848
Name:SMITH, HALEY MICHELLE (RN)
Entity type:Individual
Prefix:MISS
First Name:HALEY
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:RAVENA
Mailing Address - State:NY
Mailing Address - Zip Code:12143-1922
Mailing Address - Country:US
Mailing Address - Phone:518-424-9343
Mailing Address - Fax:
Practice Address - Street 1:25 KNISKERN AVE
Practice Address - Street 2:
Practice Address - City:MECHANICVILLE
Practice Address - State:NY
Practice Address - Zip Code:12118-2124
Practice Address - Country:US
Practice Address - Phone:518-664-7336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY792601163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool