Provider Demographics
NPI:1649358573
Name:HALLER, NANCY KRISTINE (GCFP NCMMT LMP MA)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:KRISTINE
Last Name:HALLER
Suffix:
Gender:F
Credentials:GCFP NCMMT LMP MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 S 219TH ST APT 8
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6364
Mailing Address - Country:US
Mailing Address - Phone:425-282-0406
Mailing Address - Fax:206-824-7378
Practice Address - Street 1:821 S 219TH ST APT 8
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6364
Practice Address - Country:US
Practice Address - Phone:425-282-0406
Practice Address - Fax:206-824-7378
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORGCFP1653204C00000X
OR16532081N0008X
WAMA000088772081N0008X, 225700000X
NCNCMMT0019225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0151472OtherLABOR AND INDUSTRIES
912120516OtherHMA
146525495OtherPACIFICCARE
533829001OtherGROUP HEALTH COOPERATIVE
912120516OtherAMERICAN WHOLEHEALTH NETW
341120341120OtherPREMERA
341120341120OtherLIFEWISE
912120516OtherUNITED HEALTHCARE
912120516OtherKPS
912120516OtherGUARDIAN
912120516OtherFIRST CHOICE
0005102596OtherAETNA
912120516OtherBLUE CROSS BLUE SHIELD
91212051600OtherUNIFORM
HA4253OtherREGENCE