Provider Demographics
NPI:1114076148
Name:GWINN-HALL, BETTY A (CNP)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:A
Last Name:GWINN-HALL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:A
Other - Last Name:STURTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1200 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-2754
Mailing Address - Country:US
Mailing Address - Phone:740-622-6154
Mailing Address - Fax:
Practice Address - Street 1:311 S 15TH ST STE 102
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1874
Practice Address - Country:US
Practice Address - Phone:740-622-7144
Practice Address - Fax:740-622-7166
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-05751363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSTU1-0427-9584OtherNCC PROVIDER LICENSE
OHNP76533Medicare PIN
OHSTU1-0427-9584OtherNCC PROVIDER LICENSE