Provider Demographics
NPI:1700982048
Name:HALL, DEBORAH K (FNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:K
Last Name:HALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 NORTH BALDWIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952
Mailing Address - Country:US
Mailing Address - Phone:765-664-9000
Mailing Address - Fax:765-391-1521
Practice Address - Street 1:1614 NORTH BALDWIN AVENUE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952
Practice Address - Country:US
Practice Address - Phone:765-664-9000
Practice Address - Fax:765-391-1521
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002218A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200840170Medicaid
IN200840170Medicaid
IN296260NNMedicare PIN