Provider Demographics
NPI:1417914615
Name:HALLORAN, VIVIEN JANIS (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:VIVIEN
Middle Name:JANIS
Last Name:HALLORAN
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 1:2734 BROOKVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-9784
Mailing Address - Country:US
Mailing Address - Phone:563-264-8908
Mailing Address - Fax:
Practice Address - Street 1:2979 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-2784
Practice Address - Country:US
Practice Address - Phone:563-332-8528
Practice Address - Fax:563-332-9331
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG-049173363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health