Provider Demographics
NPI:1386088144
Name:HALECKI, AMPARO ELISA (NP)
Entity type:Individual
Prefix:
First Name:AMPARO
Middle Name:ELISA
Last Name:HALECKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1134 N ROAD ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3365
Mailing Address - Country:US
Mailing Address - Phone:252-338-9451
Mailing Address - Fax:252-338-9170
Practice Address - Street 1:1134 N ROAD ST
Practice Address - Street 2:SUITE 9
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3365
Practice Address - Country:US
Practice Address - Phone:252-338-9451
Practice Address - Fax:252-338-9170
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5006165363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCC430AMedicare PIN