Healthcare Provider Details

I. General information

NPI: 1396418133
Provider Name (Legal Business Name): HALEY BATES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 NEW BRITAIN AVE
HARTFORD CT
06106-3305
US

IV. Provider business mailing address

76 NEW BRITAIN AVE
HARTFORD CT
06106-3305
US

V. Phone/Fax

Practice location:
  • Phone: 860-547-0970
  • Fax:
Mailing address:
  • Phone: 860-547-0970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number9964
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number163707
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: