Provider Demographics
NPI:1114233806
Name:HALLSTROM, ELIZABETH M (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:M
Last Name:HALLSTROM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:M
Other - Last Name:HEINZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:9500 E IRONWOOD SQUARE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4582
Mailing Address - Country:US
Mailing Address - Phone:480-948-8400
Mailing Address - Fax:401-239-1793
Practice Address - Street 1:9500 E IRONWOOD SQUARE DR STE 110
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4582
Practice Address - Country:US
Practice Address - Phone:480-948-8400
Practice Address - Fax:401-239-1793
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00059363LF0000X
AZ230160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ230160OtherNP-ARIZONA