Provider Demographics
NPI:1194703975
Name:HALL, MARTHA A (ARNP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:A
Last Name:HALL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50665-2063
Mailing Address - Country:US
Mailing Address - Phone:319-346-2331
Mailing Address - Fax:319-346-1531
Practice Address - Street 1:502 3RD ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:IA
Practice Address - Zip Code:50665-2063
Practice Address - Country:US
Practice Address - Phone:319-346-2331
Practice Address - Fax:319-346-1531
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076662363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2419168Medicaid
IA0419168Medicaid
IA3419168Medicaid
IA3419168Medicaid
IAP67715Medicare UPIN