Provider Demographics
NPI:1679568810
Name:HALIN, JAIME DANIELLE (PAC)
Entity type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:DANIELLE
Last Name:HALIN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:JAIME
Other - Middle Name:DANIELLE
Other - Last Name:BLANSETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:30 HOPE DR STE 2400
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2036
Practice Address - Country:US
Practice Address - Phone:717-531-5638
Practice Address - Fax:717-531-0983
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051372363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01699280Medicaid
PA01699280Medicaid
011209Medicare ID - Type Unspecified