Provider Demographics
NPI:1215530787
Name:HALL, REGINA Y (LVN)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:Y
Last Name:HALL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MRS
Other - First Name:REGINA
Other - Middle Name:Y
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:REGINA SMITH
Mailing Address - Street 1:8010 BLUE DUCK TRL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4494
Mailing Address - Country:US
Mailing Address - Phone:817-614-1186
Mailing Address - Fax:
Practice Address - Street 1:8010 BLUE DUCK TRL
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4494
Practice Address - Country:US
Practice Address - Phone:817-614-1186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX350875164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse