MEDICARE: MR. JAMES HALLORAN RN MSN CNS

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	364S00000X	Clinical Nurse Specialist	254965	TX

General Provider Information

NPI Number	:	1871512632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES HALLORAN RN MSN CNS

Provider Business Mailing Address
First Line	:	310 NORTHRIDGE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-2945
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 NORTHRIDGE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-2945
Country	:	US
Telephone Number	:	210-617-5300
Fax Number	:

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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