Healthcare Provider Details

I. General information

NPI: 1336177468
Provider Name (Legal Business Name): BRENDA SUE HALLS A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000B S MAIN ST
FAIRFIELD IA
52556-9572
US

IV. Provider business mailing address

2000B S MAIN ST
FAIRFIELD IA
52556-9572
US

V. Phone/Fax

Practice location:
  • Phone: 641-472-4156
  • Fax: 641-472-9436
Mailing address:
  • Phone: 641-472-4156
  • Fax: 641-472-9436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA083438
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: