Healthcare Provider Details

I. General information

NPI: 1962926097
Provider Name (Legal Business Name): STEPHANIE HALL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE ALVAREZ FNP-C

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

553 E MANHATTAN BLVD
TOLEDO OH
43608-1216
US

IV. Provider business mailing address

200 N. GRAYTOWN RD
GRAYTOWN OH
43432
US

V. Phone/Fax

Practice location:
  • Phone: 719-219-7001
  • Fax:
Mailing address:
  • Phone: 419-271-4495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number021379
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN.CNP.021379
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberAPRN.CNP.021379
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: