Provider Demographics
NPI:1083478929
Name:HALL, DIONDREA LENARD (CPRC)
Entity type:Individual
Prefix:
First Name:DIONDREA
Middle Name:LENARD
Last Name:HALL
Suffix:
Gender:
Credentials:CPRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5099 W FARRAND RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-8215
Mailing Address - Country:US
Mailing Address - Phone:586-491-1057
Mailing Address - Fax:810-496-4295
Practice Address - Street 1:1044 W BRISTOL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-5516
Practice Address - Country:US
Practice Address - Phone:810-238-0483
Practice Address - Fax:810-239-5518
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist