Provider Demographics
NPI:1487301271
Name:HALL, CHERYL RAE
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:RAE
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 S 100 W
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-2105
Mailing Address - Country:US
Mailing Address - Phone:435-632-2591
Mailing Address - Fax:435-304-6114
Practice Address - Street 1:415 N STATE ST STE 201
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-2355
Practice Address - Country:US
Practice Address - Phone:435-319-6114
Practice Address - Fax:435-304-6114
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker