Provider Demographics
NPI:1659407351
Name:HALL, TERESA E (RN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:E
Last Name:HALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 BLOUNTVILLE BYPASS
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617
Mailing Address - Country:US
Mailing Address - Phone:423-279-2777
Mailing Address - Fax:
Practice Address - Street 1:154 BLOUTVILLE BYPASS
Practice Address - Street 2:
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617-0630
Practice Address - Country:US
Practice Address - Phone:423-279-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN81118163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB58933Medicare UPIN
TN3170197Medicare PIN