Provider Demographics
NPI:1518276344
Name:HALL, ELAINA CHRISTINE
Entity Type:Individual
Prefix:MRS
First Name:ELAINA
Middle Name:CHRISTINE
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 1:309 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1107
Mailing Address - Country:US
Mailing Address - Phone:859-585-2903
Mailing Address - Fax:
Practice Address - Street 1:309 CLAY ST
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1107
Practice Address - Country:US
Practice Address - Phone:859-585-2903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200301646171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor