Provider Demographics
NPI:1427370204
Name:HALL, DEBRA (RN)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:PHILLIPS HALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:13406 GILMORE AVE.
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-2104
Mailing Address - Country:US
Mailing Address - Phone:216-262-3676
Mailing Address - Fax:
Practice Address - Street 1:13406 GILMORE AVE.
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-2104
Practice Address - Country:US
Practice Address - Phone:216-262-3676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-225597163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse