Provider Demographics
NPI:1578617478
Name:HALL, THERESA J (CNM, CRNP)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:J
Last Name:HALL
Suffix:
Gender:F
Credentials:CNM, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30185 CURTISS RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20659-3605
Mailing Address - Country:US
Mailing Address - Phone:301-884-5340
Mailing Address - Fax:
Practice Address - Street 1:975 SOLOMONS ROAD NORTH
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678
Practice Address - Country:US
Practice Address - Phone:410-535-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR053634363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health