Provider Demographics
NPI:1871106443
Name:HALE, DAISHA JANAY
Entity type:Individual
Prefix:
First Name:DAISHA
Middle Name:JANAY
Last Name:HALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 PRISCILLA AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-3213
Mailing Address - Country:US
Mailing Address - Phone:317-331-8146
Mailing Address - Fax:
Practice Address - Street 1:1401 PRISCILLA AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3213
Practice Address - Country:US
Practice Address - Phone:317-331-8146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker