Healthcare Provider Details

I. General information

NPI: 1134284805
Provider Name (Legal Business Name): DIANE P HALL RN, PCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 SALT POND RD H-3
WAKEFIELD RI
02879-4314
US

IV. Provider business mailing address

115 ROCKY BROOK WAY
WAKEFIELD RI
02879-8121
US

V. Phone/Fax

Practice location:
  • Phone: 401-789-4480
  • Fax:
Mailing address:
  • Phone: 401-788-0311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberPPNS00005
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: