Healthcare Provider Details

I. General information

NPI: 1184392896
Provider Name (Legal Business Name): HAYLEY COMRIE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4824 E BASELINE RD STE 3-125
MESA AZ
85206-4676
US

IV. Provider business mailing address

4824 E BASELINE RD STE 3-125
MESA AZ
85206-4676
US

V. Phone/Fax

Practice location:
  • Phone: 480-839-4848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number228360
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number228360
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number228360
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: