Provider Demographics
NPI:1710658182
Name:HALL, CASSANDRA RENEE
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:RENEE
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:WV
Mailing Address - Zip Code:25938-0016
Mailing Address - Country:US
Mailing Address - Phone:304-663-8467
Mailing Address - Fax:
Practice Address - Street 1:13 MELINDA DR
Practice Address - Street 2:
Practice Address - City:MT LOOKOUT
Practice Address - State:WV
Practice Address - Zip Code:26678
Practice Address - Country:US
Practice Address - Phone:304-663-8467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant