Provider Demographics
NPI:1376747642
Name:HALLISEY, JUDITH ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:HALLISEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BUCKS HILL RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-3208
Mailing Address - Country:US
Mailing Address - Phone:603-868-3330
Mailing Address - Fax:
Practice Address - Street 1:163 ROCHESTER HILL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-1728
Practice Address - Country:US
Practice Address - Phone:603-332-0238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0154972302363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics