Provider Demographics
NPI:1245585959
Name:HALVORSEN, TRISHA N (MD)
Entity Type:Individual
Prefix:DR
First Name:TRISHA
Middle Name:N
Last Name:HALVORSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:NADEEN
Other - Last Name:MORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 E KINCAID ST
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:360-428-2500
Mailing Address - Fax:360-428-6485
Practice Address - Street 1:1400 E KINCAID ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4127
Practice Address - Country:US
Practice Address - Phone:360-428-2575
Practice Address - Fax:360-428-6471
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6838207V00000X
WAMD60654825207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology