Provider Demographics
NPI:1558166926
Name:HALLBERG, STACEY
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:HALLBERG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 S 204TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-2999
Mailing Address - Country:US
Mailing Address - Phone:402-213-0147
Mailing Address - Fax:
Practice Address - Street 1:3616 S 204TH AVE
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-2999
Practice Address - Country:US
Practice Address - Phone:402-213-0147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion