1699106195 NPI number — MRS. REBECCA LYNN HALL RD

Table of content: MRS. REBECCA LYNN HALL RD (NPI 1699106195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699106195 NPI number — MRS. REBECCA LYNN HALL RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
REBECCA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWN
Provider Other First Name:
REBECCA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699106195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 758997
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-281-0626
Provider Business Mailing Address Fax Number:
804-662-7302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 EAST MARSHALL ST
Provider Second Line Business Practice Location Address:
CLINICAL NUTRITION SERVICES
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23298-0509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-828-5765
Provider Business Practice Location Address Fax Number:
804-628-0921
Provider Enumeration Date:
12/09/2013

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: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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