Provider Demographics
NPI:1134733710
Name:HEAGLE HALLER, KHRISTAN (DNP, CPNP)
Entity type:Individual
Prefix:DR
First Name:KHRISTAN
Middle Name:
Last Name:HEAGLE HALLER
Suffix:
Gender:F
Credentials:DNP, CPNP
Other - Prefix:DR
Other - First Name:KHRISTAN
Other - Middle Name:
Other - Last Name:HEAGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, APRN, CPNP
Mailing Address - Street 1:20 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-4933
Mailing Address - Country:US
Mailing Address - Phone:917-612-3781
Mailing Address - Fax:
Practice Address - Street 1:20 LOCUST LN
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-4933
Practice Address - Country:US
Practice Address - Phone:917-612-3781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY383126363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics