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

Table of content: LISA PUTNAM HALE R.N., P.N.P. (NPI 1477820033)

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".




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