Provider Demographics
NPI:1437104700
Name:HALKO, LINDA (NP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:HALKO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1668
Mailing Address - Country:US
Mailing Address - Phone:315-479-5070
Mailing Address - Fax:315-701-2520
Practice Address - Street 1:739 IRVING AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1640
Practice Address - Country:US
Practice Address - Phone:315-479-5070
Practice Address - Fax:315-701-2520
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330935363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02254520Medicaid
P04317Medicare UPIN
NY02254520Medicaid