Provider Demographics
NPI:1265562433
Name:HALL, YVONNE E (LPN LMT PHD)
Entity type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:E
Last Name:HALL
Suffix:
Gender:F
Credentials:LPN LMT PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 S, ALASKA ST.
Mailing Address - Street 2:STE 205
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645
Mailing Address - Country:US
Mailing Address - Phone:907-746-6274
Mailing Address - Fax:907-746-6278
Practice Address - Street 1:642 S ALASKA ST
Practice Address - Street 2:STE 205
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6342
Practice Address - Country:US
Practice Address - Phone:907-746-6274
Practice Address - Fax:907-746-6278
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2726204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM