Provider Demographics
NPI:1275283129
Name:HALL, ROSE J
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:J
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 1:148 BERRY LN
Mailing Address - Street 2:
Mailing Address - City:KEATCHIE
Mailing Address - State:LA
Mailing Address - Zip Code:71046-3059
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:148 BERRY LN
Practice Address - Street 2:
Practice Address - City:KEATCHIE
Practice Address - State:LA
Practice Address - Zip Code:71046-3059
Practice Address - Country:US
Practice Address - Phone:318-230-5289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide