Provider Demographics
NPI:1598589020
Name:HALL, CHRISTIAN ALEXANDER
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ALEXANDER
Last Name:HALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 N GRAND FORK DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-4750
Mailing Address - Country:US
Mailing Address - Phone:405-920-8574
Mailing Address - Fax:
Practice Address - Street 1:425 S FRETZ AVE STE C
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-5568
Practice Address - Country:US
Practice Address - Phone:405-757-7980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician