Provider Demographics
NPI:1447315890
Name:HALO, PATRICIA (FNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:HALO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 N MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4310
Mailing Address - Country:US
Mailing Address - Phone:845-638-0923
Mailing Address - Fax:845-638-6665
Practice Address - Street 1:337 N MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4310
Practice Address - Country:US
Practice Address - Phone:845-638-0923
Practice Address - Fax:845-638-6665
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400007918OtherMEDICARE PTAN