Provider Demographics
NPI:1780196535
Name:HALL, CHARLOTTE P
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:P
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 1:960 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-5292
Mailing Address - Country:US
Mailing Address - Phone:734-732-2244
Mailing Address - Fax:
Practice Address - Street 1:960 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-5292
Practice Address - Country:US
Practice Address - Phone:734-732-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health