Provider Demographics
NPI:1952335515
Name:HALVORSON, NICOLE L
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:L
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 1:1800 ROBIN AVE
Mailing Address - Street 2:S207
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-8765
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 ROBIN AVE
Practice Address - Street 2:S207
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-8765
Practice Address - Country:US
Practice Address - Phone:920-236-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician