Provider Demographics
NPI:1699509182
Name:HALEY, BRYCE
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:
Last Name:HALEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:ELIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-1083
Mailing Address - Country:US
Mailing Address - Phone:419-909-4069
Mailing Address - Fax:
Practice Address - Street 1:109 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:ELIDA
Practice Address - State:OH
Practice Address - Zip Code:45807-1083
Practice Address - Country:US
Practice Address - Phone:419-909-4069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide