Provider Demographics
NPI:1558194118
Name:HALSTED, KELSIE E
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:E
Last Name:HALSTED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 AARON DR APT 804
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-7979
Mailing Address - Country:US
Mailing Address - Phone:517-743-1297
Mailing Address - Fax:
Practice Address - Street 1:411 W LAKE LANSING RD STE B110
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8468
Practice Address - Country:US
Practice Address - Phone:517-657-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program