Individual
LOIS R HALLECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
141 S BLACK HORSE PIKE, SUITE 104, BLACKWOOD, NJ 08012-2975
(856) 292-8216
(856) 848-3011
Mailing address
141 S BLACK HORSE PIKE, SUITE 104, BLACKWOOD, NJ 08012-2975
(856) 292-8216
(856) 848-3011
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
26NR05584600
NJ
363LF0000X
Family Nurse Practitioner
Primary
26NJ00003800
NJ
Other
Enumeration date
09/06/2006
Last updated
11/18/2011
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