Provider Demographics
NPI:1821694530
Name:HALL, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
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 1:88550 4TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:UPHAM
Mailing Address - State:ND
Mailing Address - Zip Code:58789
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:88550 4TH AVE NW
Practice Address - Street 2:
Practice Address - City:UPHAM
Practice Address - State:ND
Practice Address - Zip Code:58789
Practice Address - Country:US
Practice Address - Phone:425-231-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant