Provider Demographics
NPI:1376222463
Name:HALL, BRENDA CAROL (RN, CNOR)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:CAROL
Last Name:HALL
Suffix:
Gender:F
Credentials:RN, CNOR
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:CAROL
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CNOR
Mailing Address - Street 1:420 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:WA
Mailing Address - Zip Code:99328-1339
Mailing Address - Country:US
Mailing Address - Phone:425-478-3902
Mailing Address - Fax:
Practice Address - Street 1:77 WAINWRIGHT DR RM 2417
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3975
Practice Address - Country:US
Practice Address - Phone:509-525-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60284585163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse