Provider Demographics
NPI:1326327123
Name:HALL, DEIDRA C
Entity Type:Individual
Prefix:
First Name:DEIDRA
Middle Name:C
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 W MOLTKE AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1316
Mailing Address - Country:US
Mailing Address - Phone:414-395-3947
Mailing Address - Fax:
Practice Address - Street 1:6520 W MOLTKE AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1316
Practice Address - Country:US
Practice Address - Phone:414-395-3947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator