Provider Demographics
NPI:1720696636
Name:HALEY, EMILY LOUISE (FNP)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:LOUISE
Last Name:HALEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LAGRANGE ST # 1
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-3028
Mailing Address - Country:US
Mailing Address - Phone:781-249-9711
Mailing Address - Fax:
Practice Address - Street 1:20 LAGRANGE ST # 1
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-3028
Practice Address - Country:US
Practice Address - Phone:781-249-9711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2301413363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily