Individual
GWENDOLYN ALICE HALSTED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
203 EAST MAIN STREET, RICHMOND, IN 47374
(765) 973-9294
(765) 973-9233
Mailing address
203 EAST MAIN STREET, RICHMOND, IN 47374
(765) 973-9294
(765) 973-9233
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01035332A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100321430A
—
IN
Enumeration date
10/13/2006
Last updated
11/16/2007
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