Healthcare Provider Details

I. General information

NPI: 1891985180
Provider Name (Legal Business Name): CYNTHIA GALE HALL REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 VETERANS MEMORIAL DR
TEMPLE TX
76504-7451
US

IV. Provider business mailing address

1901 VETERANS MEMORIAL DR
TEMPLE TX
76504-7451
US

V. Phone/Fax

Practice location:
  • Phone: 254-743-2896
  • Fax:
Mailing address:
  • Phone: 254-743-2896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WU0100X
TaxonomyUrology Registered Nurse
License Number649744
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WU0100X
TaxonomyUrology Registered Nurse
License NumberR0065298
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: