Provider Demographics
NPI:1730475302
Name:HALE, ELYSE A (CST)
Entity Type:Individual
Prefix:MRS
First Name:ELYSE
Middle Name:A
Last Name:HALE
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8301 OLD MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-1053
Mailing Address - Country:US
Mailing Address - Phone:270-554-8449
Mailing Address - Fax:
Practice Address - Street 1:1532 LONE OAK RD
Practice Address - Street 2:SUITE 445
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7913
Practice Address - Country:US
Practice Address - Phone:270-538-5837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist