Healthcare Provider Details

I. General information

NPI: 1740046515
Provider Name (Legal Business Name): TAMMY Y HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LUCKEY ST
ROCHESTER NY
14613-1314
US

IV. Provider business mailing address

2 LUCKEY ST
ROCHESTER NY
14613-1314
US

V. Phone/Fax

Practice location:
  • Phone: 609-536-0478
  • Fax:
Mailing address:
  • Phone: 609-536-0478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number345133
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number26NP06464500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: