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General NPI Number Information
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NPI Number | 1013624535
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Entity Type | Individual
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Provider Name | DWAYNE ALANSIER HALL DNP
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Gender | Male
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Dates
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Enumeration Date | 11/03/2022
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 130 DIVISION ST
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City | DERBY
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State | CT
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Zip | 06418-1326
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Country | US
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Telephone | 203-735-7421
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Fax |
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Provider Business Mailing Address
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Address Line | 239 LEWIS ST APT 2
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City | BRIDGEPORT
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State | CT
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Zip | 06605-1241
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Country | US
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Telephone | 203-997-1756
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 011187
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0111887
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License Number State | CT
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