Provider Demographics
NPI:1780879197
Name:HALL, ANGELA MARLENE (LPN)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MARLENE
Last Name:HALL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10910 E. S.R. 28-67
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47320
Mailing Address - Country:US
Mailing Address - Phone:765-789-4475
Mailing Address - Fax:
Practice Address - Street 1:10910 E. STATE ROAD 28-67
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47320-9140
Practice Address - Country:US
Practice Address - Phone:765-789-4475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27053703A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse