=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093356602
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. KAREN M. HALL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2019
-----------------------------------------------------
Last Update Date | 10/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11795 MAIN ST.
-----------------------------------------------------
City | VERSAILLES
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-532-2609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11795 MAIN ST. P.O. BOX 307
-----------------------------------------------------
City | VERSAILLES
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-532-2609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747A0650X
-----------------------------------------------------
Taxonomy Name | Attendant Care Provider
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------