Provider Demographics
NPI:1922217561
Name:HALL, EVELYN MARIE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:MARIE
Last Name:HALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:233 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-3145
Mailing Address - Country:US
Mailing Address - Phone:712-328-8543
Mailing Address - Fax:
Practice Address - Street 1:987740 NEBRASKA MEDICAL CTR
Practice Address - Street 2:NEONATAL INTENSIVE CARE UNIT
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-0001
Practice Address - Country:US
Practice Address - Phone:402-559-5814
Practice Address - Fax:402-559-8685
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE110417363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEQ02298Medicare UPIN