Provider Demographics
NPI:1033733647
Name:HALL, ALICE FAY
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:FAY
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11177 N ORACLE RD APT 10201
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-5649
Mailing Address - Country:US
Mailing Address - Phone:417-230-6047
Mailing Address - Fax:
Practice Address - Street 1:6320 N LA CHOLLA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3552
Practice Address - Country:US
Practice Address - Phone:520-545-0953
Practice Address - Fax:520-545-0954
Is Sole Proprietor?:No
Enumeration Date:2020-05-31
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ239719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily