Basic Information
| Provider Information | |||||||||
| NPI: | 1174243257 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FEWELL | ||||||||
| FirstName: | HAYDEE | ||||||||
| MiddleName: | BAEZA | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 PALOMINO CT | ||||||||
| Address2: | |||||||||
| City: | CANONSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153172773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137048765 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4100 ALLEQUIPPA ST | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128222222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2022 | ||||||||
| LastUpdateDate: | 08/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WM0705X | RN742399 | PA | Y | Nursing Service Providers | Registered Nurse | Medical-Surgical |
No ID Information.