Healthcare Provider Details

I. General information

NPI: 1659217412
Provider Name (Legal Business Name): HALEY QUINN ASHTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11404 W DODGE RD STE 300
OMAHA NE
68154-9603
US

IV. Provider business mailing address

9329 BINNEY ST
OMAHA NE
68134-4613
US

V. Phone/Fax

Practice location:
  • Phone: 510-861-9652
  • Fax:
Mailing address:
  • Phone: 510-861-9652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number94317
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: