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General NPI Number Information
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NPI Number | 1740851401
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Entity Type | Individual
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Provider Name | HALEY MOUND
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Gender | Female
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Dates
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Enumeration Date | 07/05/2021
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Last Update Date | 10/16/2022
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Provider Practice Location Address
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Address Line | 3711 ELMSLEY ST STE 102
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City | GREENSBORO
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State | NC
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Zip | 27406-7039
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Country | US
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Telephone | 336-890-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 3711 ELMSLEY ST STE 102
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City | GREENSBORO
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State | NC
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Zip | 27406-7039
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5014659
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License Number State | NC
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