Provider Demographics
NPI:1013675263
Name:HALL, ADDISON ANNE (AEMT)
Entity Type:Individual
Prefix:MS
First Name:ADDISON
Middle Name:ANNE
Last Name:HALL
Suffix:
Gender:F
Credentials:AEMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05658-0093
Mailing Address - Country:US
Mailing Address - Phone:760-605-4509
Mailing Address - Fax:
Practice Address - Street 1:31 DOG RIVER DR
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:VT
Practice Address - Zip Code:05663
Practice Address - Country:US
Practice Address - Phone:760-605-4509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT105061146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate