Provider Demographics
NPI:1699367144
Name:HALL, GARRETT DENNIS (BSN RN CSTR CAISS)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:DENNIS
Last Name:HALL
Suffix:
Gender:M
Credentials:BSN RN CSTR CAISS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 PEACE CHANCE DR
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3162
Mailing Address - Country:US
Mailing Address - Phone:469-243-2059
Mailing Address - Fax:
Practice Address - Street 1:525 VIA DE LOS ARBOLES
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-1827
Practice Address - Country:US
Practice Address - Phone:469-243-2059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95175781163WC1600X
MDR251538163WE0003X
TX920054163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WE0003XNursing Service ProvidersRegistered NurseEmergency