Provider Demographics
NPI:1205033453
Name:HALL, LONNIE JR (RN)
Entity Type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:
Last Name:HALL
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 BEAGLE BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-7511
Mailing Address - Country:US
Mailing Address - Phone:614-437-2664
Mailing Address - Fax:
Practice Address - Street 1:3313 BEAGLE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-7511
Practice Address - Country:US
Practice Address - Phone:614-437-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-274715163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse