Provider Demographics
NPI:1215342357
Name:HALLBLADE, BARBARA (RN)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:HALLBLADE
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 1:11030 MISSISSIPPI BLVD NW
Mailing Address - Street 2:STE 328
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-3972
Mailing Address - Country:US
Mailing Address - Phone:612-805-3474
Mailing Address - Fax:
Practice Address - Street 1:11030 MISSISSIPPI BLVD NW
Practice Address - Street 2:STE 328
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-3972
Practice Address - Country:US
Practice Address - Phone:612-805-3474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR694623163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse