Provider Demographics
NPI:1528196128
Name:HALLER, YVONNE (NP)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:HALLER
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 1:845 N 10TH ST
Mailing Address - Street 2:STE #1
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-1300
Mailing Address - Country:US
Mailing Address - Phone:805-525-5762
Mailing Address - Fax:805-525-7277
Practice Address - Street 1:845 N 10TH ST
Practice Address - Street 2:STE #1
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-1300
Practice Address - Country:US
Practice Address - Phone:805-525-5762
Practice Address - Fax:805-525-7277
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANPF15084363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner