Provider Demographics
NPI:1699179614
Name:HALL, ANDREA M (RN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
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 1:104 CHERYL ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14903-1004
Mailing Address - Country:US
Mailing Address - Phone:607-737-5215
Mailing Address - Fax:607-737-5219
Practice Address - Street 1:150 LAKE ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3401
Practice Address - Country:US
Practice Address - Phone:607-737-5215
Practice Address - Fax:607-737-5219
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY593725163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse