Provider Demographics
NPI:1548730583
Name:HALSTEAD, DEBORAH S
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:S
Last Name:HALSTEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6624 DELPHI RD SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512-2122
Mailing Address - Country:US
Mailing Address - Phone:360-259-2856
Mailing Address - Fax:
Practice Address - Street 1:700 ISRAEL RD SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-5450
Practice Address - Country:US
Practice Address - Phone:360-709-7635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00046289164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse