Basic Information
Provider Information
NPI: 1770981284
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HALEY
FirstName: VALERIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: R.N.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3567 FORT MEADE RD
Address2: APT 406
City: LAUREL
State: MD
PostalCode: 207242012
CountryCode: US
TelephoneNumber: 3018020513
FaxNumber:  
Practice Location
Address1: 9475 LOTTSFORD RD
Address2: SUITE 250
City: LARGO
State: MD
PostalCode: 207745357
CountryCode: US
TelephoneNumber: 3016366504
FaxNumber: 3016366509
Other Information
ProviderEnumerationDate: 12/15/2014
LastUpdateDate: 12/15/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XR194113MDY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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