Provider Demographics
NPI:1679087639
Name:HALL, ZHENA LAVERNE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ZHENA
Middle Name:LAVERNE
Last Name:HALL
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:ZHENA
Other - Middle Name:LAVERNE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:2931 KING JAMES WAY
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1674
Mailing Address - Country:US
Mailing Address - Phone:608-209-9670
Mailing Address - Fax:
Practice Address - Street 1:2931 KING JAMES WAY
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-1674
Practice Address - Country:US
Practice Address - Phone:608-209-9670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI228847-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse