Provider Demographics
NPI:1861455545
Name:HALL, PAMELA GAIL (CRN)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:GAIL
Last Name:HALL
Suffix:
Gender:F
Credentials:CRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 HOCH RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:OH
Mailing Address - Zip Code:43342-9779
Mailing Address - Country:US
Mailing Address - Phone:740-382-8298
Mailing Address - Fax:740-382-8298
Practice Address - Street 1:1991 HOCH RD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:OH
Practice Address - Zip Code:43342-9779
Practice Address - Country:US
Practice Address - Phone:740-382-8298
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 071170363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2503946Medicaid