Provider Demographics
NPI:1619623444
Name:HALL, OLIVIA KRISTINE
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:KRISTINE
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 1:1006 FRANKLYN ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-3523
Mailing Address - Country:US
Mailing Address - Phone:315-404-0940
Mailing Address - Fax:
Practice Address - Street 1:801 LAUREL ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-3229
Practice Address - Country:US
Practice Address - Phone:315-338-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY771433163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool