Provider Demographics
NPI:1588242705
Name:PETERMAN, HAYLEE L (FNP-BC)
Entity type:Individual
Prefix:
First Name:HAYLEE
Middle Name:L
Last Name:PETERMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17000 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7200
Mailing Address - Country:US
Mailing Address - Phone:810-625-2916
Mailing Address - Fax:
Practice Address - Street 1:5467 HILL 23 DRIVE
Practice Address - Street 2:FLINT
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507
Practice Address - Country:US
Practice Address - Phone:810-720-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704307317NSA2108I363L00000X
MI4704307317363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner