Provider Demographics
NPI:1801060892
Name:HALL, CLARICE REBECCA (FNP-BC)
Entity type:Individual
Prefix:
First Name:CLARICE
Middle Name:REBECCA
Last Name:HALL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18125 WOODSFIELD RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-9709
Practice Address - Country:US
Practice Address - Phone:740-732-7259
Practice Address - Fax:740-732-7360
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.09998-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2844337Medicaid
WV3810027731Medicaid
OHP01225683OtherRAILROAD MEDICARE
WV3810027731Medicaid
OHP01225683OtherRAILROAD MEDICARE
OH000000699822OtherANTHEM