Provider Demographics
NPI:1154149557
Name:KLOSS, HALEY JO (NP)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:JO
Last Name:KLOSS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3197 HEYNIG RD
Mailing Address - Street 2:
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740-9318
Mailing Address - Country:US
Mailing Address - Phone:231-838-7240
Mailing Address - Fax:
Practice Address - Street 1:39393 VAN DYKE AVE STE 101
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-4636
Practice Address - Country:US
Practice Address - Phone:313-403-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704363173363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care