Provider Demographics
NPI:1417701376
Name:HALL, KATHLEEN CAROL (LPN)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:CAROL
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 1:58 1/2 PHILIP ST APT 4
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12202-2785
Mailing Address - Country:US
Mailing Address - Phone:518-894-8339
Mailing Address - Fax:
Practice Address - Street 1:195 WOLF RD STE 105
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1100
Practice Address - Country:US
Practice Address - Phone:518-374-0152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196686-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse