Provider Demographics
NPI:1922385004
Name:HALL, RILLIS C (LPN)
Entity Type:Individual
Prefix:
First Name:RILLIS
Middle Name:C
Last Name:HALL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 STERLING AVE
Mailing Address - Street 2:APT# 203
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1626
Mailing Address - Country:US
Mailing Address - Phone:724-346-0459
Mailing Address - Fax:
Practice Address - Street 1:335 STERLING AVE
Practice Address - Street 2:APT# 203
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-1626
Practice Address - Country:US
Practice Address - Phone:724-346-0459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN145095-MEDS164W00000X
PAPN287829164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse