Provider Demographics
NPI:1780954503
Name:HALLEN, ELISSA (RN, CDE)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:
Last Name:HALLEN
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 CRAUT ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-1503
Mailing Address - Country:US
Mailing Address - Phone:415-533-9293
Mailing Address - Fax:415-641-6829
Practice Address - Street 1:3555 CESAR CHAVEZ
Practice Address - Street 2:DIABETES CENTER ROOM 230
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4403
Practice Address - Country:US
Practice Address - Phone:415-533-9293
Practice Address - Fax:415-641-6829
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA422033163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator