Provider Demographics
NPI:1790012979
Name:HALAT, DEANA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:MARIE
Last Name:HALAT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DEANA
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-788-9292
Mailing Address - Fax:303-788-9260
Practice Address - Street 1:125 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2546
Practice Address - Country:US
Practice Address - Phone:303-788-9292
Practice Address - Fax:303-788-9260
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10046363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO306494Medicare PIN