Provider Demographics
NPI:1407187933
Name:HALL, IRENE V (LPN)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:V
Last Name:HALL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3291 COUNTY ROUTE 57
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-6437
Mailing Address - Country:US
Mailing Address - Phone:315-532-0311
Mailing Address - Fax:
Practice Address - Street 1:3291 COUNTY ROUTE 57
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6437
Practice Address - Country:US
Practice Address - Phone:315-532-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258770164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse