Provider Demographics
NPI:1396403754
Name:HALLS, MICHELLE (RN)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:HALLS
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 1:878 EDWARDS BLVD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1321
Mailing Address - Country:US
Mailing Address - Phone:917-373-5754
Mailing Address - Fax:
Practice Address - Street 1:878 EDWARDS BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-1321
Practice Address - Country:US
Practice Address - Phone:917-373-5754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY813500163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse