Provider Demographics
NPI:1073985651
Name:HALL, QUEZIA (PA)
Entity Type:Individual
Prefix:
First Name:QUEZIA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4951 S WHITE MOUNTAIN RD BLDG A
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7827
Mailing Address - Country:US
Mailing Address - Phone:928-537-6700
Mailing Address - Fax:928-537-9581
Practice Address - Street 1:4951 S WHITE MOUNTAIN RD BLDG A
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7827
Practice Address - Country:US
Practice Address - Phone:928-537-6700
Practice Address - Fax:928-537-9581
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6241363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant