Provider Demographics
NPI:1427331958
Name:HALL, DIANN B (RN)
Entity type:Individual
Prefix:MS
First Name:DIANN
Middle Name:B
Last Name:HALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2437 ALOHA LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-7744
Mailing Address - Country:US
Mailing Address - Phone:904-215-2266
Mailing Address - Fax:904-215-2266
Practice Address - Street 1:2437 ALOHA LN
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-7744
Practice Address - Country:US
Practice Address - Phone:904-215-2266
Practice Address - Fax:904-215-2266
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLRN 099533163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL$$$$$$$$$Medicaid