Provider Demographics
NPI:1295256279
Name:HALLING, NICOLE (BSN, RN, IBCLC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:HALLING
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12320 SE STATE ROUTE A
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-7413
Mailing Address - Country:US
Mailing Address - Phone:816-294-5001
Mailing Address - Fax:
Practice Address - Street 1:12320 SE STATE ROUTE A
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-7413
Practice Address - Country:US
Practice Address - Phone:816-294-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOL-66864163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant