Healthcare Provider Details

I. General information

NPI: 1598315848
Provider Name (Legal Business Name): LARA HALL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LARA E GROVER

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 N 10TH ST
HAMILTON MT
59840-2357
US

IV. Provider business mailing address

209 N 10TH ST STE A
HAMILTON MT
59840-2357
US

V. Phone/Fax

Practice location:
  • Phone: 406-532-9140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberNUR-RN-LIC-145661
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: