Provider Demographics
NPI:1336979053
Name:HALLER, ISAAK WAYNE
Entity type:Individual
Prefix:
First Name:ISAAK
Middle Name:WAYNE
Last Name:HALLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10885 JUDAS RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43164-9773
Mailing Address - Country:US
Mailing Address - Phone:740-600-0422
Mailing Address - Fax:
Practice Address - Street 1:6530 STATE ROUTE 772
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8843
Practice Address - Country:US
Practice Address - Phone:740-464-0426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide