Provider Demographics
NPI:1508256942
Name:HALLAM, LINDA LOU ANN (RN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LOU ANN
Last Name:HALLAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N ORANGE ST
Mailing Address - Street 2:P O BOX 178
Mailing Address - City:BUTLER
Mailing Address - State:MO
Mailing Address - Zip Code:64730-1325
Mailing Address - Country:US
Mailing Address - Phone:660-679-6108
Mailing Address - Fax:660-679-6022
Practice Address - Street 1:501 N ORANGE ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-1325
Practice Address - Country:US
Practice Address - Phone:660-679-6108
Practice Address - Fax:660-679-6022
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014021302163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse