Provider Demographics
NPI:1285955567
Name:HALL, SHERINE ANDRIA (RN)
Entity type:Individual
Prefix:
First Name:SHERINE
Middle Name:ANDRIA
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 1:1005 ANSTON DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2979
Mailing Address - Country:US
Mailing Address - Phone:678-477-6828
Mailing Address - Fax:
Practice Address - Street 1:1005 ANSTON DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2979
Practice Address - Country:US
Practice Address - Phone:678-477-6828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN191878163W00000X, 163WH0200X, 163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support