Provider Demographics
NPI:1831435320
Name:HALTER, TAMMY (LPN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:HALTER
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 1:58 STEGES RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12743-5000
Mailing Address - Country:US
Mailing Address - Phone:845-557-0330
Mailing Address - Fax:
Practice Address - Street 1:99 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-6026
Practice Address - Country:US
Practice Address - Phone:845-357-4500
Practice Address - Fax:845-357-5039
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272808164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse