Provider Demographics
NPI:1659151918
Name:HALSTEAD, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HALSTEAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23968 DANIEL BOONE PKWY
Mailing Address - Street 2:
Mailing Address - City:PEYTONA
Mailing Address - State:WV
Mailing Address - Zip Code:25154
Mailing Address - Country:US
Mailing Address - Phone:304-369-4308
Mailing Address - Fax:
Practice Address - Street 1:23968 DANIEL BOONE PKWY
Practice Address - Street 2:
Practice Address - City:PEYTONA
Practice Address - State:WV
Practice Address - Zip Code:25154
Practice Address - Country:US
Practice Address - Phone:304-369-4308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker