Provider Demographics
NPI:1467969717
Name:HALBERT-RAICH, PATRICIA (FNP-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:HALBERT-RAICH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 WAMPLERS HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MI
Mailing Address - Zip Code:49230-9573
Mailing Address - Country:US
Mailing Address - Phone:517-403-4087
Mailing Address - Fax:
Practice Address - Street 1:818 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1446
Practice Address - Country:US
Practice Address - Phone:517-265-0491
Practice Address - Fax:517-265-0209
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.192629363LF0000X
MI4704209997363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily