Provider Demographics
NPI:1457815532
Name:HALL, AMY M (APN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:HALL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:MERZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:1405 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2367
Mailing Address - Country:US
Mailing Address - Phone:217-337-3240
Mailing Address - Fax:217-337-3241
Practice Address - Street 1:1405 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2367
Practice Address - Country:US
Practice Address - Phone:217-337-3240
Practice Address - Fax:217-337-3241
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017853363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner