Provider Demographics
NPI:1841296886
Name:HALASZ, DENISE MARIE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:MARIE
Last Name:HALASZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:FOURNIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2310 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:FORT LEWIS
Mailing Address - State:WA
Mailing Address - Zip Code:98433-1041
Mailing Address - Country:US
Mailing Address - Phone:253-962-2736
Mailing Address - Fax:
Practice Address - Street 1:9040 A FITZSIMMONS AVE.
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-967-9594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006956363L00000X
WARN00158414363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8853526Medicare ID - Type Unspecified
WAQ43873Medicare UPIN