Healthcare Provider Details

I. General information

NPI: 1639031149
Provider Name (Legal Business Name): HAILEY COUNTRYMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9399 MADISON AVE STE 103
ORANGEVALE CA
95662-4976
US

IV. Provider business mailing address

7227 CHURCH ST
PENRYN CA
95663-9411
US

V. Phone/Fax

Practice location:
  • Phone: 916-827-5571
  • Fax: 916-827-5571
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: