Individual
KELLY ELIZABETH HALBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
744 S WEBSTER AVE, GREEN BAY, WI 54301-3505
(920) 433-3500
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7210
(920) 445-7289
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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