Healthcare Provider Details

I. General information

NPI: 1780049981
Provider Name (Legal Business Name): EUGENIA MARIE HALL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040A JACKSON AVE MADIGAN ARMY MEDICAL CENTER
TACOMA WA
98431-1000
US

IV. Provider business mailing address

9040A JACKSON AVE
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-5207
  • Fax: 253-968-6026
Mailing address:
  • Phone: 253-968-5207
  • Fax: 253-968-6026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9269809
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number9269809
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: