Provider Demographics
NPI:1205816261
Name:HALL, ANDREA M (MSN, CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:M
Last Name:HALL
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 CLARK AVE
Mailing Address - Street 2:SUITE 13
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1438
Mailing Address - Country:US
Mailing Address - Phone:610-265-8566
Mailing Address - Fax:610-878-2620
Practice Address - Street 1:625 CLARK AVE
Practice Address - Street 2:SUITE 13
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1438
Practice Address - Country:US
Practice Address - Phone:610-265-8566
Practice Address - Fax:610-878-2620
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008617363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q43015Medicare UPIN
PA090718RA7Medicare ID - Type Unspecified