Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | D0078686 | MD |
NPI | 1568412088 |
---|---|
Provider Name | Lisa Marie Halvorson |
First Address | Rockville, MD 20850-2739 |
Second Address | Rockville, MD 20850-2739 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 19/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
155350501 | (05) | TX |
F61376 | (02) |