Provider Demographics
NPI:1235763012
Name:HALL, ANNETTE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W MCCREIGHT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1853
Mailing Address - Country:US
Mailing Address - Phone:373-993-2339
Mailing Address - Fax:937-342-5979
Practice Address - Street 1:30 W MCCREIGHT AVE STE 100
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1853
Practice Address - Country:US
Practice Address - Phone:373-993-2339
Practice Address - Fax:937-342-5979
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.026295363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily