Provider Demographics
NPI:1043942766
Name:GRAVELY, HALEY ELISE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:ELISE
Last Name:GRAVELY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1793 13TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2541
Mailing Address - Country:US
Mailing Address - Phone:503-362-8385
Mailing Address - Fax:503-362-8435
Practice Address - Street 1:19917 7TH AVE NE STE 101
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6555
Practice Address - Country:US
Practice Address - Phone:360-824-5474
Practice Address - Fax:360-994-4975
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH50.007657RX363A00000X
WAPA61396582363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant