Healthcare Provider Details

I. General information

NPI: 1083426019
Provider Name (Legal Business Name): PORSHA LASHAY HALL NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9706 KENNEDY AVE
CLEVELAND OH
44104
US

IV. Provider business mailing address

9706 KENNEDY AVE
CLEVELAND OH
44104-3450
US

V. Phone/Fax

Practice location:
  • Phone: 216-202-1902
  • Fax:
Mailing address:
  • Phone: 404-309-2495
  • Fax: 216-399-3521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1083426019
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: