Provider Demographics
NPI:1629708011
Name:HALL, MARLINA DANIELLE (DPO, ABOC, NCLEC)
Entity Type:Individual
Prefix:MRS
First Name:MARLINA
Middle Name:DANIELLE
Last Name:HALL
Suffix:
Gender:F
Credentials:DPO, ABOC, NCLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 KEYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:TIPTONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38079-4042
Mailing Address - Country:US
Mailing Address - Phone:731-445-3313
Mailing Address - Fax:731-884-0250
Practice Address - Street 1:1601 W REELFOOT AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5554
Practice Address - Country:US
Practice Address - Phone:731-884-0255
Practice Address - Fax:731-884-0250
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1902156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician