Provider Demographics
NPI:1316140726
Name:HALM, LENORA MAY (IP)
Entity type:Individual
Prefix:
First Name:LENORA
Middle Name:MAY
Last Name:HALM
Suffix:
Gender:F
Credentials:IP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4176 STATE ROUTE 600
Mailing Address - Street 2:
Mailing Address - City:GIBSONBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43431-9702
Mailing Address - Country:US
Mailing Address - Phone:419-650-8184
Mailing Address - Fax:
Practice Address - Street 1:4176 STATE ROUTE 600
Practice Address - Street 2:
Practice Address - City:GIBSONBURG
Practice Address - State:OH
Practice Address - Zip Code:43431-9702
Practice Address - Country:US
Practice Address - Phone:419-650-8184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2141168174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2141168Medicaid