1013044528 NPI number — MS. DEVONNE P HALL LPN

Table of content: DAILYN GONZALEZ (NPI 1912660614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013044528 NPI number — MS. DEVONNE P HALL LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
DEVONNE
Provider Middle Name:
P
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013044528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
88005 OVERSEAS HIGHWAY
Provider Second Line Business Mailing Address:
SUITE 16
Provider Business Mailing Address City Name:
ISLAMORADA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-593-9711
Provider Business Mailing Address Fax Number:
305-425-2228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
88005 OVERSEAS HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE 16
Provider Business Practice Location Address City Name:
ISLAMORADA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-593-9711
Provider Business Practice Location Address Fax Number:
305-425-2228
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  204741-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002909900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02498231 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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