MEDICARE: HALEY LARA LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	326252	TX

General Provider Information

NPI Number	:	1508580580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY LARA LPN

Provider Business Mailing Address
First Line	:	15608 W ACAPULCO LN
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85379-6225
Country	:	US
Telephone Number	:	210-978-6909
Fax Number	:

Provider Business Practice Location Address
First Line	:	10909 N PERRYVILLE RD
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85388-9713
Country	:	US
Telephone Number	:	623-876-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2022
Last Update Date	:	10/03/2022

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Directions to “ HALEY LARA LPN” Practice Location

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