Provider Demographics
NPI:1346432424
Name:HALIBURTON, CAROLYN DENISE (RN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:DENISE
Last Name:HALIBURTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4005
Mailing Address - Country:US
Mailing Address - Phone:540-793-1318
Mailing Address - Fax:
Practice Address - Street 1:3707 COLONIAL AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4005
Practice Address - Country:US
Practice Address - Phone:540-793-1318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001145401163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse