Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 003385 | CT |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 003385 | CT |
NPI | 1033178132 |
---|---|
Provider Name | Lisa Michele Halpern |
First Address | Wethersfield, CT 06109-4362 |
Second Address | Wethersfield, CT 06109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2006 |
Last Update Date | 11/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004033858 | (05) | CT |
500001785 | MEDICARE (01) | CT |
D400085831 | MEDICARE (01) | CT |
D400085832 | MEDICARE (01) | CT |
Q72666 | (02) | CT |