Provider Demographics
NPI:1336204163
Name:HALSTEAD, R. RENEE (CNM NP RN)
Entity type:Individual
Prefix:
First Name:R.
Middle Name:RENEE
Last Name:HALSTEAD
Suffix:
Gender:F
Credentials:CNM NP RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 MEDICAL CENTER DR E #101
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611
Mailing Address - Country:US
Mailing Address - Phone:559-297-9500
Mailing Address - Fax:559-297-9572
Practice Address - Street 1:722 MEDICAL CENTER DR E #101
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611
Practice Address - Country:US
Practice Address - Phone:559-297-9500
Practice Address - Fax:559-297-9572
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMW147176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANMW001470Medicaid
CANMW001470Medicaid