Healthcare Provider Details

I. General information

NPI: 1831191030
Provider Name (Legal Business Name): MELLISA A HALL N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N MAIN ST
PRINCETON IN
47670-1540
US

IV. Provider business mailing address

108 N MAIN ST
PRINCETON IN
47670-1540
US

V. Phone/Fax

Practice location:
  • Phone: 812-753-1039
  • Fax: 812-753-1122
Mailing address:
  • Phone: 812-753-1039
  • Fax: 812-753-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71000055A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: