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General NPI Number Information
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NPI Number | 1598640062
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Entity Type | Individual
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Provider Name | HALEY DIEDRICK DNP, RN, CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 6330 SAN VICENTE BLVD STE 500
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City | LOS ANGELES
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State | CA
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Zip | 90048-5455
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Country | US
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Telephone | 310-854-0770
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Fax |
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Provider Business Mailing Address
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Address Line | 18734 HONEY TREE LN
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City | NORTHVILLE
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State | MI
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Zip | 48168-8605
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 95036514
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 95430562
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License Number State | CA
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