1134520018 NPI number — CHRISTOPHER TIMOTHY HALL APRN, RNFA

Table of content: CHRISTOPHER TIMOTHY HALL APRN, RNFA (NPI 1134520018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134520018 NPI number — CHRISTOPHER TIMOTHY HALL APRN, RNFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
CHRISTOPHER
Provider Middle Name:
TIMOTHY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, RNFA
Provider Gender Code:
M

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:
1134520018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 PRINGLE WAY STE 1002
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89502-1475
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-323-7500
Provider Business Mailing Address Fax Number:
775-789-9208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3237 SUSILEEN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89509-3859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-313-7779
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/10/2014

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: 163WR0006X , with the licence number:  RN60561 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: APRN002618 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1134520018 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: CEP11471 . This is a "RNFA PROVIDER NUMBER" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: RN60561 . This is a "REGISTERED NURSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: APRN002618 . This is a "ADVANCED PRACTICE REGISTERED NURSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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