Provider Demographics
NPI:1104167782
Name:HALL, TRACIE (RN)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 WILCOX LN
Mailing Address - Street 2:
Mailing Address - City:MUNFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36268-7410
Mailing Address - Country:US
Mailing Address - Phone:256-493-5449
Mailing Address - Fax:
Practice Address - Street 1:246 WILCOX LN
Practice Address - Street 2:
Practice Address - City:MUNFORD
Practice Address - State:AL
Practice Address - Zip Code:36268-7410
Practice Address - Country:US
Practice Address - Phone:256-493-5449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-108731163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse