=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316480403
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HALEY CLAUSE NP-C, RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2016
-----------------------------------------------------
Last Update Date | 04/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1045 N LAKE AVE FL 2
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91104-4521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-798-0706
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2333 LAKE AVE FL 2
-----------------------------------------------------
City | ALTADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91001-2463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-798-0706
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 721413
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | 421265
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------