Healthcare Provider Details

I. General information

NPI: 1891224937
Provider Name (Legal Business Name): HALEY BILS PILKENTON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2017
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W GRAND AVE
DAYTON OH
45405-7538
US

IV. Provider business mailing address

9470 COPPERTON DR
CENTERVILLE OH
45458-3962
US

V. Phone/Fax

Practice location:
  • Phone: 419-889-8465
  • Fax:
Mailing address:
  • Phone: 419-889-8465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number116832
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number116832
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number392218
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: