Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 30.020312 | OH |
NPI | 1083863633 |
---|---|
Provider Name | Dr. Sandra M. Halterman |
First Address | Norfolk, VA 23511 |
Second Address | Norfolk, VA 23511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2008 |
Last Update Date | 18/09/2008 |