Healthcare Provider Details

I. General information

NPI: 1528245321
Provider Name (Legal Business Name): KIMBERLY HALFMANN MSRD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 CENTRE ST
BROCKTON MA
02302-3308
US

IV. Provider business mailing address

680 CENTRE ST
BROCKTON MA
02302-3308
US

V. Phone/Fax

Practice location:
  • Phone: 508-941-7252
  • Fax: 508-941-6412
Mailing address:
  • Phone: 508-941-7252
  • Fax: 508-941-6412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number2630
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: