Provider Demographics
NPI:1417213091
Name:HALL, JOHN DAVIS (LPN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVIS
Last Name:HALL
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 GRACE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-3602
Mailing Address - Country:US
Mailing Address - Phone:315-396-9814
Mailing Address - Fax:
Practice Address - Street 1:166 GRACE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-3602
Practice Address - Country:US
Practice Address - Phone:315-396-9814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-08
Last Update Date:2012-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298003164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse