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General NPI Number Information
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NPI Number | 1275529224
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Entity Type | Individual
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Provider Name | JENNIFER T HALEY MD
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Gender | Female
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 3480 WOLVERINE DR SUITE F
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City | MONTROSE
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State | CO
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Zip | 81401-4965
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Country | US
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Telephone | 970-252-7444
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Fax | 970-252-3446
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Provider Business Mailing Address
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Address Line | 3780 WOLVERINE DRIVE STE F
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City | MONTROSE
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State | CO
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Zip | 81401-4965
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Country | US
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Telephone | 970-252-7444
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Fax | 970-252-3446
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 47465
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License Number State | CO
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