Provider Demographics
NPI:1700325859
Name:HALLMARK, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:HALLMARK
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 1:30 BABCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:14136-1503
Mailing Address - Country:US
Mailing Address - Phone:716-785-1213
Mailing Address - Fax:
Practice Address - Street 1:30 BABCOCK AVE
Practice Address - Street 2:
Practice Address - City:SILVER CREEK
Practice Address - State:NY
Practice Address - Zip Code:14136-1503
Practice Address - Country:US
Practice Address - Phone:716-785-1213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254221-1164W00000X
NY734943163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse