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General NPI Number Information
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NPI Number | 1649358573
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Entity Type | Individual
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Provider Name | NANCY KRISTINE HALLER GCFP NCMMT LMP MA
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 03/31/2023
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Provider Practice Location Address
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Address Line | 821 S 219TH ST APT 8
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City | DES MOINES
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State | WA
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Zip | 98198-6364
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Country | US
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Telephone | 425-282-0406
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Fax | 206-824-7378
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Provider Business Mailing Address
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Address Line | 821 S 219TH ST APT 8
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City | DES MOINES
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State | WA
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Zip | 98198-6364
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Country | US
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Telephone | 425-282-0406
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Fax | 206-824-7378
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | GCFP1653
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 2081N0008X
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Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 1653
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 2081N0008X
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Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | MA00008877
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | NCMMT0019
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00008877
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License Number State | WA
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