Provider Demographics
NPI:1003070996
Name:HALL, KAREN OLSEN (BS RD)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:OLSEN
Last Name:HALL
Suffix:
Gender:F
Credentials:BS RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3769
Mailing Address - Street 2:
Mailing Address - City:PINETOP
Mailing Address - State:AZ
Mailing Address - Zip Code:85935-3769
Mailing Address - Country:US
Mailing Address - Phone:928-242-5098
Mailing Address - Fax:
Practice Address - Street 1:2332 HALL DR
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-5604
Practice Address - Country:US
Practice Address - Phone:928-242-5098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered