Provider Demographics
NPI:1275952368
Name:HALLIBURTON, NICHOLE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:HALLIBURTON
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4215
Mailing Address - Fax:513-636-5867
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:EPIDERMOLYSIS BULLOSA CENTER ML 15005
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-2009
Practice Address - Fax:513-803-4438
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.15673-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily