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General NPI Number Information
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NPI Number | 1619478021
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Entity Type | Individual
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Provider Name | NICHOLAS L HALL
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Gender | Male
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 11/28/2018
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Provider Practice Location Address
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Address Line | 2954 WALNUT ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-4828
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Country | US
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Telephone | 740-353-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 2408 ARGILLITE RD APT 2
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City | FLATWOODS
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State | KY
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Zip | 41139-1384
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Country | US
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Telephone |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | CDCA.165217
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License Number State | OH
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