Provider Demographics
NPI:1174527097
Name:DIANA, HAILEY L (CRNA)
Entity type:Individual
Prefix:MRS
First Name:HAILEY
Middle Name:L
Last Name:DIANA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:HAILEY
Other - Middle Name:L
Other - Last Name:SCHRECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8325 PRESERVE PKWY
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-8350
Mailing Address - Country:US
Mailing Address - Phone:315-692-4012
Mailing Address - Fax:
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1807
Practice Address - Country:US
Practice Address - Phone:315-448-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY517274367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q05342Medicare UPIN