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General NPI Number Information
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NPI Number | 1265100903
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Entity Type | Individual
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Provider Name | NICOLE ELIZABETH HANEY NP
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Gender | Female
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Dates
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Enumeration Date | 08/30/2021
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 20770 W MARKET ST STE 101
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City | BUCKEYE
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State | AZ
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Zip | 85396-8042
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Country | US
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Telephone | 32-162-3873
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Fax |
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Provider Business Mailing Address
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Address Line | 16569 W CHARLOTTE DR
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City | SURPRISE
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State | AZ
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Zip | 85387-2190
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Country | US
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Telephone | 623-698-2174
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 321912
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN200834
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License Number State | AZ
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