Provider Demographics
NPI:1033178132
Name:HALPERN, LISA MICHELE (APRN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELE
Last Name:HALPERN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 SILAS DEANE HWY
Mailing Address - Street 2:HARTFORD HOSPITAL NEUROLOGY DEPT
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4362
Mailing Address - Country:US
Mailing Address - Phone:860-696-2820
Mailing Address - Fax:
Practice Address - Street 1:1260 SILAS DEANE HWY
Practice Address - Street 2:HARTFORD HOSPITAL NEUROLOGY DEPT
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109
Practice Address - Country:US
Practice Address - Phone:860-696-2820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003385363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004033858Medicaid
CT500001785OtherMEDICARE
CTD400085831OtherMEDICARE
CTD400085832OtherMEDICARE