Provider Demographics
NPI:1538242292
Name:HALEY-WIEN, SARAH ELISABETH (DO)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ELISABETH
Last Name:HALEY-WIEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ELISABETH
Other - Last Name:WIENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2ID, UNIT 15041
Mailing Address - Street 2:BOX 692
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96258-4106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:133 ROUTE 3
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-6911
Practice Address - Country:US
Practice Address - Phone:671-645-5546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.942207P00000X
OH34.009072207P00000X
NC2013-00013207P00000X
GUDO-0071207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUH109390Medicare Oscar/Certification