Provider Demographics
NPI:1942710447
Name:HALL-EDERER, CRISTY LEANN (DNP)
Entity Type:Individual
Prefix:DR
First Name:CRISTY
Middle Name:LEANN
Last Name:HALL-EDERER
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2474 ROAD 218
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-9149
Mailing Address - Country:US
Mailing Address - Phone:405-888-9992
Mailing Address - Fax:
Practice Address - Street 1:5890 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4308
Practice Address - Country:US
Practice Address - Phone:307-337-4058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993097-NP363LF0000X
WY40548-1655363LF0000X
NC5010868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily