Provider Demographics
NPI:1730602376
Name:VANDENBERG, HAYLEY RAE (PA)
Entity type:Individual
Prefix:MS
First Name:HAYLEY
Middle Name:RAE
Last Name:VANDENBERG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HAYLEY
Other - Middle Name:RAE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-3010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:608 RADAM LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1172
Practice Address - Country:US
Practice Address - Phone:512-443-5988
Practice Address - Fax:512-443-5055
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA18331363A00000X
CAPA57700363AS0400X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant