MEDICARE: MRS. TAMARA LYNN HALL LPN

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	164W00000X	Licensed Practical Nurse	103689	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861607236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMARA LYNN HALL LPN

Provider Business Mailing Address
First Line	:	1145 TWP RD 1293
Second Line	:
City	:	ASHLAND
State	:	OH
Zip	:	44805-0000
Country	:	US
Telephone Number	:	419-651-1949
Fax Number	:

Provider Business Practice Location Address
First Line	:	1145 TWP RD 1293
Second Line	:
City	:	ASHLAND
State	:	OH
Zip	:	44805-0000
Country	:	US
Telephone Number	:	419-651-1949
Fax Number	:

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

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	05/17/2016

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