1477820033 NPI number — LISA PUTNAM HALE R.N., P.N.P.

Table of content: (NPI 1134374663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477820033 NPI number — LISA PUTNAM HALE R.N., P.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALE
Provider First Name:
LISA
Provider Middle Name:
PUTNAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.N., P.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477820033
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
747 52ND STREET, HEMATOLOGY-ONCOLOGY DEPARTMENT
Provider Second Line Business Mailing Address:
CHILDREN'S HOSPITAL & RESEARCH CENTER AT OAKLAND
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-428-3885
Provider Business Mailing Address Fax Number:
510-597-7199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
747 52ND STREET, HEMATOLOGY-ONCOLOGY DEPARTMENT
Provider Second Line Business Practice Location Address:
CHILDREN'S HOSPITAL & RESEARCH CENTER AT OAKLAND
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-428-3885
Provider Business Practice Location Address Fax Number:
510-597-7199
Provider Enumeration Date:
11/28/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  732596 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: 21022 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20113310 . This is a "NATIONAL PNP CERTIFICATION PEDIATRIC NURSING CERT BOARD" identifier . This identifiers is of the category "OTHER".