Provider Demographics
NPI:1578357844
Name:HALEY, TERRELLE
Entity type:Individual
Prefix:
First Name:TERRELLE
Middle Name:
Last Name:HALEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4854 TAYLOR ST APT 4
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-5247
Mailing Address - Country:US
Mailing Address - Phone:402-578-3178
Mailing Address - Fax:
Practice Address - Street 1:4854 TAYLOR ST APT 4
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-5247
Practice Address - Country:US
Practice Address - Phone:402-578-3178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant