Provider Demographics
NPI:1780170217
Name:HALLENBERGER, KRISTA MARIE (LVN)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:MARIE
Last Name:HALLENBERGER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 COOKSTON LN
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-8621
Mailing Address - Country:US
Mailing Address - Phone:805-300-4229
Mailing Address - Fax:
Practice Address - Street 1:221 COOKSTON LN
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-8621
Practice Address - Country:US
Practice Address - Phone:805-300-4229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343325164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse