Provider Demographics
NPI:1336833607
Name:GUGGENHEIM, HALEY NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:NICOLE
Last Name:GUGGENHEIM
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 BRINELL ST E APT 131
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3790
Mailing Address - Country:US
Mailing Address - Phone:216-513-5725
Mailing Address - Fax:
Practice Address - Street 1:4919 DIERKER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2946
Practice Address - Country:US
Practice Address - Phone:614-457-4952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH505.008197RX363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0019123Medicaid