Provider Demographics
NPI:1093987505
Name:HALL, VIRGINIA RAE (LPN)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:RAE
Last Name:HALL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:OTWAY
Mailing Address - State:OH
Mailing Address - Zip Code:45657-9092
Mailing Address - Country:US
Mailing Address - Phone:740-372-5002
Mailing Address - Fax:
Practice Address - Street 1:207 DAVIS RD
Practice Address - Street 2:
Practice Address - City:OTWAY
Practice Address - State:OH
Practice Address - Zip Code:45657-9092
Practice Address - Country:US
Practice Address - Phone:740-372-5002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH111397164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse