| Doctor Name: | HAILEY ENTREMONT |
| NPI Number: | 1104120138 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | AP06251 |
| Business Practice Address: | 2647 S Saint Elizabeth Blvd Gonzales, LA - 707375021 |
| Business Phone Number: | 2256478511 |
| Business Fax Number: | 2256445213 |
| Mailing Address: | 2647 S Saint Elizabeth Blvd, GONZALES |
| State: | LA |
| Postal Code: | 707375021 |
| Phone Number: | 2256478511 |
| Fax Number: | 2256445213 |
| NPI Enumeration Date: | 01/05/2011 |
| NPI Last Update Date: | 08/25/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP06251 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |