Provider Demographics
NPI:1629310354
Name:HALSETH, DAVONNE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:DAVONNE
Middle Name:
Last Name:HALSETH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:DAVONNE
Other - Middle Name:
Other - Last Name:HALSETH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1875 OVERVIEW DRIVE N.E.
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422
Mailing Address - Country:US
Mailing Address - Phone:218-251-5629
Mailing Address - Fax:
Practice Address - Street 1:1875 OVERVIEW DR NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-4245
Practice Address - Country:US
Practice Address - Phone:218-251-5629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN 60330676163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse