Provider Demographics
NPI:1710191663
Name:HALL, DANNA M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DANNA
Middle Name:M
Last Name:HALL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 SUNNYSIDE AVE
Mailing Address - Street 2:PUTH
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207
Mailing Address - Country:US
Mailing Address - Phone:718-827-9766
Mailing Address - Fax:718-827-9766
Practice Address - Street 1:81 OCEAN PARKWAY
Practice Address - Street 2:3B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11281
Practice Address - Country:US
Practice Address - Phone:718-871-1365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2696981164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02821061Medicaid