Provider Demographics
NPI:1902606585
Name:HALL, AMIE (CERTIFIED NURSE AIDE)
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:HALL
Suffix:
Gender:
Credentials:CERTIFIED NURSE AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 N GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-1656
Mailing Address - Country:US
Mailing Address - Phone:765-274-8610
Mailing Address - Fax:
Practice Address - Street 1:1511 N GRANT AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-1656
Practice Address - Country:US
Practice Address - Phone:765-274-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCNA1001870376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide