1972674646 NPI number — MS. LADONNA JOAN HALEY RN MS MN APN CNS PMH

Table of content: VERONIKA R FREI (NPI 1033713631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972674646 NPI number — MS. LADONNA JOAN HALEY RN MS MN APN CNS PMH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALEY
Provider First Name:
LADONNA
Provider Middle Name:
JOAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN MS MN APN CNS PMH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOFER
Provider Other First Name:
LADONNA
Provider Other Middle Name:
JOAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972674646
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3060
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSION
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-583-8815
Provider Business Mailing Address Fax Number:
956-583-2436

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1605 EAST GRIFFIN PARKWAY
Provider Second Line Business Practice Location Address:
D
Provider Business Practice Location Address City Name:
MISSION
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-583-8815
Provider Business Practice Location Address Fax Number:
956-583-2436
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SP0808X , with the licence number:  AP106339 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 029327601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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