Provider Demographics
NPI:1790241925
Name:HALSTEAD, KIRSTEN ELIZABETH (RN)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:ELIZABETH
Last Name:HALSTEAD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HOLSTROM CIR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-2073
Mailing Address - Country:US
Mailing Address - Phone:415-320-4840
Mailing Address - Fax:
Practice Address - Street 1:1950 FRANKLIN ST FL 8
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-5190
Practice Address - Country:US
Practice Address - Phone:510-987-4912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN447445163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse