Healthcare Provider Details

I. General information

NPI: 1417733635
Provider Name (Legal Business Name): HALEY BRYNNE HLELA MSN, ACCNS-P, CPHQ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 09/04/2023
Certification Date: 09/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4395
US

IV. Provider business mailing address

3500 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4395
US

V. Phone/Fax

Practice location:
  • Phone: 215-264-3142
  • Fax:
Mailing address:
  • Phone: 215-264-3142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License NumberCNS000287
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: