Provider Demographics
NPI:1518300300
Name:HALTER, COURTNEY E (LPN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:E
Last Name:HALTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 224
Mailing Address - Street 2:
Mailing Address - City:NUNDA
Mailing Address - State:NY
Mailing Address - Zip Code:14517-0224
Mailing Address - Country:US
Mailing Address - Phone:585-991-2118
Mailing Address - Fax:
Practice Address - Street 1:2539 DEGROFF RD
Practice Address - Street 2:
Practice Address - City:NUNDA
Practice Address - State:NY
Practice Address - Zip Code:14517-9639
Practice Address - Country:US
Practice Address - Phone:585-991-2118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306581-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse