Provider Demographics
NPI:1982385738
Name:ROSS, HALEY
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BUCKS DR
Mailing Address - Street 2:
Mailing Address - City:LAKE LYNN
Mailing Address - State:PA
Mailing Address - Zip Code:15451-1096
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 BUCKS DR
Practice Address - Street 2:
Practice Address - City:LAKE LYNN
Practice Address - State:PA
Practice Address - Zip Code:15451-1096
Practice Address - Country:US
Practice Address - Phone:301-616-5443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program