Healthcare Provider Details

I. General information

NPI: 1326541871
Provider Name (Legal Business Name): HALO HEALTH & PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N GRANDVIEW AVE
DUBUQUE IA
52001-6388
US

IV. Provider business mailing address

PO BOX 758
DUBUQUE IA
52004-0758
US

V. Phone/Fax

Practice location:
  • Phone: 563-557-2894
  • Fax:
Mailing address:
  • Phone: 563-542-8783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANGEL KELLER
Title or Position: OWNER
Credential: NP
Phone: 563-542-8782