Provider Demographics
NPI:1336947118
Name:HALEY, TY'NAE
Entity type:Individual
Prefix:
First Name:TY'NAE
Middle Name:
Last Name:HALEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 N 54TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-2819
Mailing Address - Country:US
Mailing Address - Phone:402-541-5697
Mailing Address - Fax:
Practice Address - Street 1:4325 N 54TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-2819
Practice Address - Country:US
Practice Address - Phone:402-541-5697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide