Healthcare Provider Details

I. General information

NPI: 1093577124
Provider Name (Legal Business Name): WENDY HALL PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 US HIGHWAY 395 N
GARDNERVILLE NV
89410-5304
US

IV. Provider business mailing address

PO BOX 2516
CARSON CITY NV
89702-2516
US

V. Phone/Fax

Practice location:
  • Phone: 775-782-1630
  • Fax: 775-782-1632
Mailing address:
  • Phone: 423-280-6902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number870189
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number109081
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number870189
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: