Provider Demographics
NPI:1093823544
Name:HALLUM, BARBARA G (ARNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:G
Last Name:HALLUM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12333 NE 130TH LN
Mailing Address - Street 2:#320
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3039
Mailing Address - Country:US
Mailing Address - Phone:425-899-0555
Mailing Address - Fax:425-899-1333
Practice Address - Street 1:12333 NE 130TH LN
Practice Address - Street 2:#302
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7467
Practice Address - Country:US
Practice Address - Phone:425-899-0555
Practice Address - Fax:425-899-1333
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001999363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9607250Medicaid
WAAB28188Medicare ID - Type Unspecified
WA9607250Medicaid