Provider Demographics
NPI:1174846133
Name:HALBACH, LINDSAY A (LPN)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:A
Last Name:HALBACH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2637 E STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-9737
Mailing Address - Country:US
Mailing Address - Phone:608-481-4508
Mailing Address - Fax:
Practice Address - Street 1:2637 E STATE LINE RD
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-9737
Practice Address - Country:US
Practice Address - Phone:608-481-4508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI303017-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse