Provider Demographics
NPI:1134595820
Name:HALL, MEGAN MARLENE
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MARLENE
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 RED BANK RD STE 110
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-2177
Mailing Address - Country:US
Mailing Address - Phone:513-564-1366
Mailing Address - Fax:513-564-1367
Practice Address - Street 1:4440 RED BANK RD STE 110
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227
Practice Address - Country:US
Practice Address - Phone:513-564-1366
Practice Address - Fax:513-564-1367
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 18719 NP363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology