Provider Demographics
NPI:1740834779
Name:HALLAGER, NIKEETA (LPN)
Entity type:Individual
Prefix:
First Name:NIKEETA
Middle Name:
Last Name:HALLAGER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 ROBBINS ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-5821
Mailing Address - Country:US
Mailing Address - Phone:267-939-8191
Mailing Address - Fax:
Practice Address - Street 1:1341 ROBBINS ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-5821
Practice Address - Country:US
Practice Address - Phone:267-939-8191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN285384164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse