Provider Demographics
NPI:1023377520
Name:HALLAHAN, RAEANNE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:RAEANNE
Middle Name:
Last Name:HALLAHAN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MERRIMAC
Mailing Address - State:MA
Mailing Address - Zip Code:01860-1520
Mailing Address - Country:US
Mailing Address - Phone:978-478-8104
Mailing Address - Fax:
Practice Address - Street 1:80 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MERRIMAC
Practice Address - State:MA
Practice Address - Zip Code:01860-1520
Practice Address - Country:US
Practice Address - Phone:978-478-8104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA230569163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse