Provider Demographics
NPI:1508896119
Name:HALL, JANET S (CRNA)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:S
Last Name:HALL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 HITCHING POST LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-4912
Mailing Address - Country:US
Mailing Address - Phone:843-708-5691
Mailing Address - Fax:843-553-2223
Practice Address - Street 1:2690 LAKE PARK DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9100
Practice Address - Country:US
Practice Address - Phone:843-553-7070
Practice Address - Fax:843-553-2223
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN2322367500000X
SC38705367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0677Medicaid
SCQ313877137Medicare ID - Type Unspecified
SCAN0677Medicaid