Provider Demographics
NPI:1972775401
Name:HALE, VIRGINIA ILAINE (RN)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ILAINE
Last Name:HALE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 S 8TH DR
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-6751
Mailing Address - Country:US
Mailing Address - Phone:928-532-0452
Mailing Address - Fax:
Practice Address - Street 1:2 W. 3RD ST
Practice Address - Street 2:
Practice Address - City:CIBECUE
Practice Address - State:AZ
Practice Address - Zip Code:85911
Practice Address - Country:US
Practice Address - Phone:928-332-2560
Practice Address - Fax:928-332-2418
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN023551163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse