Provider Demographics
NPI:1760186928
Name:HALL, TRACIA SHERELLE
Entity Type:Individual
Prefix:
First Name:TRACIA
Middle Name:SHERELLE
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 1:2515 38TH. ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709
Mailing Address - Country:US
Mailing Address - Phone:330-705-5157
Mailing Address - Fax:
Practice Address - Street 1:2515 38TH. ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709
Practice Address - Country:US
Practice Address - Phone:330-705-5157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker