Provider Demographics
NPI:1447836564
Name:HALBEISEN, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:HALBEISEN
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 1:401 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:GREEN SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:44836-9779
Mailing Address - Country:US
Mailing Address - Phone:419-307-5657
Mailing Address - Fax:
Practice Address - Street 1:401 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:GREEN SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:44836-9779
Practice Address - Country:US
Practice Address - Phone:419-307-5657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty