Provider Demographics
NPI:1346332533
Name:HALL-HARRIS, EVELYN (NPA)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:HALL-HARRIS
Suffix:
Gender:F
Credentials:NPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 35456
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235
Mailing Address - Country:US
Mailing Address - Phone:804-862-2878
Mailing Address - Fax:804-862-2879
Practice Address - Street 1:40 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5021
Practice Address - Country:US
Practice Address - Phone:804-862-2878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024131004363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00X544A02OtherINDIVIDUAL NUMBER
VA0024131004OtherSTATE ID
VA00X544A02OtherINDIVIDUAL NUMBER