MEDICARE: MANDISA HALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	666542	NY
2	163W00000X	Registered Nurse	666542	NY

General Provider Information

NPI Number	:	1366804353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDISA HALL

Provider Business Mailing Address
First Line	:	511 CLEVELAND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-2119
Country	:	US
Telephone Number	:	917-957-0648
Fax Number	:

Provider Business Practice Location Address
First Line	:	511 CLEVELAND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-2119
Country	:	US
Telephone Number	:	917-957-0648
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2016
Last Update Date	:	04/11/2016

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Directions to “ MANDISA HALL ” Practice Location

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