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General NPI Number Information
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NPI Number | 1972386977
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Entity Type | Individual
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Provider Name | HAILEY FRIEDRICH PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/15/2023
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 10215 BROADWAY STE 207
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City | CROWN POINT
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State | IN
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Zip | 46307-8001
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Country | US
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Telephone | 219-661-6171
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Fax | 219-703-6836
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Provider Business Mailing Address
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Address Line | 8558 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7032
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Country | US
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Telephone | 219-392-7084
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Fax | 219-703-6854
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10004190A
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License Number State | IN
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