Provider Demographics
NPI:1376870444
Name:HALL, TONIA PICOU
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:PICOU
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 1:1515 S SALCEDO ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-2829
Mailing Address - Country:US
Mailing Address - Phone:504-827-2557
Mailing Address - Fax:504-827-5558
Practice Address - Street 1:4911 PERELLI DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-3529
Practice Address - Country:US
Practice Address - Phone:504-827-2557
Practice Address - Fax:504-827-5558
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA152557251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA$$$$$$$$$Medicaid