Healthcare Provider Details

I. General information

NPI: 1376451989
Provider Name (Legal Business Name): NICOLETTE HALEY, FAMILY HEALTH NURSE PRACTITIONER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 TAMARACK ST
UTICA NY
13502-1322
US

IV. Provider business mailing address

532 TAMARACK ST
UTICA NY
13502-1322
US

V. Phone/Fax

Practice location:
  • Phone: 315-360-1880
  • Fax:
Mailing address:
  • Phone: 315-360-1880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NICOLETTE PAGE
Title or Position: OWNER, NURSE PRACTITIONER
Credential:
Phone: 315-360-1880