Provider Demographics
NPI:1891043535
Name:HALBROOK, DANIELLE AUTUMN (RN)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:AUTUMN
Last Name:HALBROOK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 LARKSPUR LOOP
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7267
Mailing Address - Country:US
Mailing Address - Phone:541-285-8397
Mailing Address - Fax:
Practice Address - Street 1:1617 LARKSPUR LOOP
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7267
Practice Address - Country:US
Practice Address - Phone:541-285-8397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201242432RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health