Provider Demographics
NPI:1497433478
Name:HALL, DEBRA NALYNN
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:NALYNN
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3663 ROLLISTON RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-5136
Mailing Address - Country:US
Mailing Address - Phone:216-553-9740
Mailing Address - Fax:
Practice Address - Street 1:3663 ROLLISTON RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-5136
Practice Address - Country:US
Practice Address - Phone:216-553-9740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage