Provider Demographics
NPI:1629787833
Name:HALL, ELIZABETH (LVN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33403 CORTE MANGARINO
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-9448
Mailing Address - Country:US
Mailing Address - Phone:951-514-6286
Mailing Address - Fax:
Practice Address - Street 1:33403 CORTE MANGARINO
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-9448
Practice Address - Country:US
Practice Address - Phone:951-514-6286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA719075164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse