Provider Demographics
NPI:1568613289
Name:HALL, STEPHANIE RACHEL (CASE MANAGER)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RACHEL
Last Name:HALL
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SUGAR LANE
Mailing Address - Street 2:HC 74 BOX 22213
Mailing Address - City:EL PRADO
Mailing Address - State:NM
Mailing Address - Zip Code:87529
Mailing Address - Country:US
Mailing Address - Phone:479-530-0305
Mailing Address - Fax:
Practice Address - Street 1:413 SIPAPU ST
Practice Address - Street 2:BOX 6952
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6489
Practice Address - Country:US
Practice Address - Phone:575-758-5857
Practice Address - Fax:575-758-2832
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator