Provider Demographics
NPI:1083596324
Name:HALEY, HOLLIE JEAN (RN)
Entity type:Individual
Prefix:
First Name:HOLLIE
Middle Name:JEAN
Last Name:HALEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 RUSSIA RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13431-2815
Mailing Address - Country:US
Mailing Address - Phone:315-335-0340
Mailing Address - Fax:
Practice Address - Street 1:9005 OLD RIVER RD
Practice Address - Street 2:
Practice Address - City:MARCY
Practice Address - State:NY
Practice Address - Zip Code:13403-3000
Practice Address - Country:US
Practice Address - Phone:315-765-3615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY793546163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse