Healthcare Provider Details

I. General information

NPI: 1073739306
Provider Name (Legal Business Name): ANITA SUE HALE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 AGVIK STREET
BARROW AL
99723-0029
US

IV. Provider business mailing address

204 RUSSELL ST
SHELBYVILLE TN
37160-4815
US

V. Phone/Fax

Practice location:
  • Phone: 907-852-4611
  • Fax:
Mailing address:
  • Phone: 931-684-1526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number47290
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: