Provider Demographics
NPI:1710203492
Name:HALL, PAUL DOUGLAS (RN)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DOUGLAS
Last Name:HALL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 E HIGHWAY 18
Mailing Address - Street 2:PHS INDAIN HOSPITAL
Mailing Address - City:PINE RIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57770
Mailing Address - Country:US
Mailing Address - Phone:605-867-3067
Mailing Address - Fax:
Practice Address - Street 1:1201 E HIGHWAY 18
Practice Address - Street 2:PHS INDAIN HOSPITAL
Practice Address - City:PINE RIDGE
Practice Address - State:SD
Practice Address - Zip Code:57770
Practice Address - Country:US
Practice Address - Phone:605-867-3067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX728077163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse