Provider Demographics
NPI:1972082329
Name:HALTINNER, LISA (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HALTINNER
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 1:117 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3831
Mailing Address - Country:US
Mailing Address - Phone:248-965-6605
Mailing Address - Fax:
Practice Address - Street 1:117 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3831
Practice Address - Country:US
Practice Address - Phone:248-965-6605
Practice Address - Fax:615-468-4583
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704288440163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1780047365OtherTHIRD PARTY INSURANCE