Individual
KELLY ELIZABETH HALBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
4078-23
WI
363AS0400X
Surgical Physician Assistant
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1142855
NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS
—
Enumeration date
05/30/2017
Last updated
12/27/2022
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