MEDICARE: DEBRA NALYNN 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	251X00000X	Supports Brokerage Agency

General Provider Information

NPI Number	:	1497433478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA NALYNN HALL

Provider Business Mailing Address
First Line	:	3663 ROLLISTON RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-5136
Country	:	US
Telephone Number	:	216-553-9740
Fax Number	:

Provider Business Practice Location Address
First Line	:	3663 ROLLISTON RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-5136
Country	:	US
Telephone Number	:	216-553-9740
Fax Number	:

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

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	07/10/2023

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