Provider Demographics
NPI:1316779622
Name:HALL, ALYSIA DAWN
Entity type:Individual
Prefix:
First Name:ALYSIA
Middle Name:DAWN
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSIA
Other - Middle Name:DAWN
Other - Last Name:CONKEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HALL
Mailing Address - Street 1:4124 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5163
Mailing Address - Country:US
Mailing Address - Phone:740-961-1789
Mailing Address - Fax:
Practice Address - Street 1:4124 TAFT ST
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:OH
Practice Address - Zip Code:45662-5163
Practice Address - Country:US
Practice Address - Phone:740-961-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide