Provider Demographics
NPI:1194305615
Name:HALLAUER, KRISTIN DAWN (RN)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DAWN
Last Name:HALLAUER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 CONVOY CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1014
Mailing Address - Country:US
Mailing Address - Phone:866-940-2218
Mailing Address - Fax:
Practice Address - Street 1:6911 CONVOY CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1014
Practice Address - Country:US
Practice Address - Phone:866-940-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA521057163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse