Provider Demographics
NPI:1306468285
Name:HANEY, BIANCA
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:HANEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2922 NORTHERN BLDVD
Mailing Address - Street 2:APT. 3311
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11101-3780
Mailing Address - Country:US
Mailing Address - Phone:414-241-1234
Mailing Address - Fax:
Practice Address - Street 1:560 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3917
Practice Address - Country:US
Practice Address - Phone:212-305-5756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127381367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered