Provider Demographics
NPI:1437683760
Name:HALL, PATRICIA JR (STNA)
Entity Type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:
Last Name:HALL
Suffix:JR
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13313 SAINT JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-1640
Mailing Address - Country:US
Mailing Address - Phone:216-754-9621
Mailing Address - Fax:
Practice Address - Street 1:13313 SAINT JAMES AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-1640
Practice Address - Country:US
Practice Address - Phone:216-754-9621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401618990314376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide