MEDICARE: HALEY MAE FUCHS

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	363A00000X	Physician Assistant	PA60992650	WA

General Provider Information

NPI Number	:	1588147185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY MAE FUCHS

Provider Business Mailing Address
First Line	:	700 LILLY RD NE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-5115
Country	:	US
Telephone Number	:	360-923-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 MORAGA WAY STE G
Second Line	:
City	:	ORINDA
State	:	CA
Zip	:	94563-3019
Country	:	US
Telephone Number	:	760-618-1353
Fax Number	:

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

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	01/06/2023

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