Healthcare Provider Details

I. General information

NPI: 1205421625
Provider Name (Legal Business Name): ANNA LEE HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W LOMBARD ST
BALTIMORE MD
21201-1512
US

IV. Provider business mailing address

734 LIGHT ST APT 1
BALTIMORE MD
21230-3849
US

V. Phone/Fax

Practice location:
  • Phone: 443-371-1649
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberR204086
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: