Provider Demographics
NPI:1841960671
Name:HALEY, JON (RN)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:HALEY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MILO
Mailing Address - State:ME
Mailing Address - Zip Code:04463-1729
Mailing Address - Country:US
Mailing Address - Phone:207-943-7752
Mailing Address - Fax:
Practice Address - Street 1:135 PARK ST
Practice Address - Street 2:
Practice Address - City:MILO
Practice Address - State:ME
Practice Address - Zip Code:04463-1729
Practice Address - Country:US
Practice Address - Phone:207-943-7752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN64711163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)