Healthcare Provider Details

I. General information

NPI: 1033453345
Provider Name (Legal Business Name): GENNY BETH HALL R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 CHEMAWA ROAD NE
SALEM OR
97305-1111
US

IV. Provider business mailing address

3750 CHEMAWA ROAD NE
SALEM OR
97305-1111
US

V. Phone/Fax

Practice location:
  • Phone: 503-304-7600
  • Fax: 503-304-7678
Mailing address:
  • Phone: 503-304-7600
  • Fax: 503-304-7678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200940352RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: