Provider Demographics
NPI:1669737185
Name:HALL, BOSE C
Entity type:Individual
Prefix:MRS
First Name:BOSE
Middle Name:C
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 1:4283 58TH AVE APT A
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1914
Mailing Address - Country:US
Mailing Address - Phone:240-350-4572
Mailing Address - Fax:
Practice Address - Street 1:4283 58TH AVE APT A
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1914
Practice Address - Country:US
Practice Address - Phone:240-350-4572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374UOOOOOX374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide