Healthcare Provider Details

I. General information

NPI: 1275084261
Provider Name (Legal Business Name): HAYLEY MARIE BOISSEAU PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2723 HORSE PEN CREEK RD STE 105
GREENSBORO NC
27410-8390
US

IV. Provider business mailing address

2723 HORSE PEN CREEK RD STE 105
GREENSBORO NC
27410-8390
US

V. Phone/Fax

Practice location:
  • Phone: 336-265-1762
  • Fax: 336-510-1000
Mailing address:
  • Phone: 336-265-1762
  • Fax: 336-510-1000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110005453
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-09620
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: