Provider Demographics
NPI:1285756221
Name:HALEY, DOROLA VIRGINIA (FNP)
Entity type:Individual
Prefix:MS
First Name:DOROLA
Middle Name:VIRGINIA
Last Name:HALEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1319 ARROYO GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-2928
Mailing Address - Country:US
Mailing Address - Phone:916-591-1319
Mailing Address - Fax:916-482-0262
Practice Address - Street 1:2000 BROADWAY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2304
Practice Address - Country:US
Practice Address - Phone:510-891-3546
Practice Address - Fax:510-891-2834
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA153539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily