MEDICARE: STARLA HALVERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP61670584	WA

General Provider Information

NPI Number	:	1063212546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STARLA HALVERSON

Provider Business Mailing Address
First Line	:	4117 S MERIDIAN
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98373-3697
Country	:	US
Telephone Number	:	253-648-0115
Fax Number	:

Provider Business Practice Location Address
First Line	:	4117 S MERIDIAN
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98373-3697
Country	:	US
Telephone Number	:	253-648-0115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2025
Last Update Date	:	01/03/2026

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Directions to “ STARLA HALVERSON ” Practice Location

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