Provider Demographics
NPI:1346652484
Name:VON HALL, LUANA
Entity Type:Individual
Prefix:
First Name:LUANA
Middle Name:
Last Name:VON 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 1:2080 SHIRLEY DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-5448
Mailing Address - Country:US
Mailing Address - Phone:314-702-3164
Mailing Address - Fax:
Practice Address - Street 1:2080 SHIRLEY DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-5448
Practice Address - Country:US
Practice Address - Phone:314-702-3164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO286500000286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital