Provider Demographics
NPI:1578160305
Name:HALL, CRYSTAL MAE
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MAE
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 1:354 TRIMBLE RD
Mailing Address - Street 2:
Mailing Address - City:NETTIE
Mailing Address - State:WV
Mailing Address - Zip Code:26681-4655
Mailing Address - Country:US
Mailing Address - Phone:304-618-7738
Mailing Address - Fax:
Practice Address - Street 1:354 TRIMBLE RD
Practice Address - Street 2:
Practice Address - City:NETTIE
Practice Address - State:WV
Practice Address - Zip Code:26681-4655
Practice Address - Country:US
Practice Address - Phone:304-618-7738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant