Healthcare Provider Details

I. General information

NPI: 1023973690
Provider Name (Legal Business Name): HALEY HOLBORN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 LAKE TAPPS PKWY SE STE 110
AUBURN WA
98092-8376
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 253-939-7181
  • Fax: 253-939-7184
Mailing address:
  • Phone: 726-202-3039
  • Fax: 210-978-5592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI70075244
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: