Provider Demographics
NPI:1548875255
Name:HALLER, CHARLEE (LM, CPM, MSM)
Entity type:Individual
Prefix:
First Name:CHARLEE
Middle Name:
Last Name:HALLER
Suffix:
Gender:F
Credentials:LM, CPM, MSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5632 SILVERADO TRL
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-9412
Mailing Address - Country:US
Mailing Address - Phone:925-550-3699
Mailing Address - Fax:
Practice Address - Street 1:5632 SILVERADO TRL
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-9412
Practice Address - Country:US
Practice Address - Phone:925-550-3699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM615176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife