Provider Demographics
NPI:1740893205
Name:HALVORSON, REBECCA LOISE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LOISE
Last Name:HALVORSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 893
Mailing Address - Street 2:
Mailing Address - City:DANIELS
Mailing Address - State:WV
Mailing Address - Zip Code:25832-0893
Mailing Address - Country:US
Mailing Address - Phone:571-396-1632
Mailing Address - Fax:
Practice Address - Street 1:202 EDWARDS LN
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813-8879
Practice Address - Country:US
Practice Address - Phone:681-207-1936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant