Provider Demographics
NPI:1679059315
Name:BASCO, HALLEL PARALUMAN MAULLON (FNP-C, RN)
Entity Type:Individual
Prefix:
First Name:HALLEL PARALUMAN
Middle Name:MAULLON
Last Name:BASCO
Suffix:
Gender:F
Credentials:FNP-C, RN
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Mailing Address - Street 1:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:4730 N SOUTHSIDE PLAZA ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-1742
Practice Address - Country:US
Practice Address - Phone:804-230-7777
Practice Address - Fax:804-230-2071
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0001260044163W00000X
VA0024176375363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse