Healthcare Provider Details

I. General information

NPI: 1306014303
Provider Name (Legal Business Name): LYNN MARIE HALL APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 MAPLE LN
ASHLAND WI
54806-3626
US

IV. Provider business mailing address

1615 MAPLE LANE
ASHLAND WI
54806
US

V. Phone/Fax

Practice location:
  • Phone: 715-685-5400
  • Fax: 715-685-5102
Mailing address:
  • Phone: 715-685-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number159779-30
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8488-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: