Provider Demographics
NPI:1164602793
Name:HALL, AMITY (PA)
Entity Type:Individual
Prefix:
First Name:AMITY
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:875 BLAKE WILBUR DRIVE
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5820
Mailing Address - Country:US
Mailing Address - Phone:650-736-2066
Mailing Address - Fax:650-736-0220
Practice Address - Street 1:875 BLAKE WILBUR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5820
Practice Address - Country:US
Practice Address - Phone:650-736-2066
Practice Address - Fax:650-736-0220
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA19463363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical