Provider Demographics
NPI:1093356602
Name:HALL, KAREN M
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:M
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 1:11795 MAIN ST. P.O. BOX 307
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:NY
Mailing Address - Zip Code:14168
Mailing Address - Country:US
Mailing Address - Phone:716-532-2609
Mailing Address - Fax:
Practice Address - Street 1:11795 MAIN ST.
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:NY
Practice Address - Zip Code:14168
Practice Address - Country:US
Practice Address - Phone:716-532-2609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider