Provider Demographics
NPI:1295415818
Name:HALL, JOANNA SUE
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:SUE
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 1:3667 DINGESS RD
Mailing Address - Street 2:
Mailing Address - City:DINGESS
Mailing Address - State:WV
Mailing Address - Zip Code:25671-0273
Mailing Address - Country:US
Mailing Address - Phone:304-752-8402
Mailing Address - Fax:
Practice Address - Street 1:3667 DINGESS RD
Practice Address - Street 2:
Practice Address - City:DINGESS
Practice Address - State:WV
Practice Address - Zip Code:25671-0273
Practice Address - Country:US
Practice Address - Phone:304-752-8402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider