Healthcare Provider Details

I. General information

NPI: 1700206208
Provider Name (Legal Business Name): MELANIE Y HALL APRN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 RICHMOND RD SUITE 201
RICHMOND HEIGHTS OH
44143-2792
US

IV. Provider business mailing address

464 RICHMOND RD SUITE 201
RICHMOND HEIGHTS OH
44143-2792
US

V. Phone/Fax

Practice location:
  • Phone: 216-881-5055
  • Fax:
Mailing address:
  • Phone: 216-881-5055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberOH3004735
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15904-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: