Provider Demographics
NPI:1568669505
Name:HALL, ANGELA G
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:G
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 1:1157 N RENEE CT
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IN
Mailing Address - Zip Code:47165-7907
Mailing Address - Country:US
Mailing Address - Phone:812-967-4490
Mailing Address - Fax:
Practice Address - Street 1:1157 N RENEE CT
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IN
Practice Address - Zip Code:47165-7907
Practice Address - Country:US
Practice Address - Phone:812-967-4490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver