Provider Demographics
NPI:1588458046
Name:ANGLIN, HALEY
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:ANGLIN
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 1:208 QUEENSBURY CT
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2254
Mailing Address - Country:US
Mailing Address - Phone:302-893-7374
Mailing Address - Fax:
Practice Address - Street 1:208 QUEENSBURY CT
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2254
Practice Address - Country:US
Practice Address - Phone:302-893-7374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist