Provider Demographics
NPI:1598315848
Name:HALL, LARA (RN)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:E
Other - Last Name:GROVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:209 N 10TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2357
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 N 10TH ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2357
Practice Address - Country:US
Practice Address - Phone:406-532-9140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-145661163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult