Healthcare Provider Details

I. General information

NPI: 1336204163
Provider Name (Legal Business Name): R. RENEE HALSTEAD CNM NP RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 MEDICAL CENTER DR E #101
CLOVIS CA
93611
US

IV. Provider business mailing address

722 MEDICAL CENTER DR E #101
CLOVIS CA
93611
US

V. Phone/Fax

Practice location:
  • Phone: 559-297-9500
  • Fax: 559-297-9572
Mailing address:
  • Phone: 559-297-9500
  • Fax: 559-297-9572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberNMW147
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: