Healthcare Provider Details

I. General information

NPI: 1598984247
Provider Name (Legal Business Name): BYNETTA REJINA HALL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CREEKSIDE DR
MAPLE HEIGHTS OH
44137-4780
US

IV. Provider business mailing address

150 CREEKSIDE DR
MAPLE HEIGHTS OH
44137-4780
US

V. Phone/Fax

Practice location:
  • Phone: 216-587-0734
  • Fax:
Mailing address:
  • Phone: 216-587-0734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN282221
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: