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General NPI Number Information
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NPI Number | 1548066137
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Entity Type | Individual
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Provider Name | HAYLEE INTISO-LENO AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 505 HIGHWAY 17 N
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City | NORTH MYRTLE BEACH
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State | SC
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Zip | 29582-2903
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Country | US
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Telephone | 843-663-1307
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Fax |
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Provider Business Mailing Address
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Address Line | 4059 SYLVAN LP
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City | MYRTLE BEACH
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State | SC
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Zip | 29588-3008
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APN.29774.RX
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License Number State | SC
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