=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356701866
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERRI B HALL NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2016
-----------------------------------------------------
Last Update Date | 02/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 340 BAGLEY CIR
-----------------------------------------------------
City | MARION
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24354-3126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-783-1200
-----------------------------------------------------
Fax | 276-783-9712
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 340 BAGLEY CIR
-----------------------------------------------------
City | MARION
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24354-3126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-783-1200
-----------------------------------------------------
Fax | 276-783-9712
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 0024173321
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------