Provider Demographics
NPI:1477218220
Name:HALL, DELORES (STNA)
Entity Type:Individual
Prefix:
First Name:DELORES
Middle Name:
Last Name:HALL
Suffix:
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 1:2335 POLLOCK RD
Mailing Address - Street 2:
Mailing Address - City:MC DERMOTT
Mailing Address - State:OH
Mailing Address - Zip Code:45652-9033
Mailing Address - Country:US
Mailing Address - Phone:740-529-9252
Mailing Address - Fax:
Practice Address - Street 1:2389 POLLOCK RD
Practice Address - Street 2:
Practice Address - City:MC DERMOTT
Practice Address - State:OH
Practice Address - Zip Code:45652-9033
Practice Address - Country:US
Practice Address - Phone:740-259-5818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401871560616374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide