Healthcare Provider Details

I. General information

NPI: 1730665597
Provider Name (Legal Business Name): BROOKE HALL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 LANKFORD ST
CLAY CITY IN
47841-1008
US

IV. Provider business mailing address

221 S 6TH ST
TERRE HAUTE IN
47807-4214
US

V. Phone/Fax

Practice location:
  • Phone: 812-939-2126
  • Fax: 812-939-3414
Mailing address:
  • Phone: 812-232-0564
  • Fax: 812-242-4590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71008106A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: