Provider Demographics
NPI:1982427134
Name:HALL, DELROSE W
Entity type:Individual
Prefix:
First Name:DELROSE
Middle Name:W
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 1:225 PLUMEGRASS RUN
Mailing Address - Street 2:
Mailing Address - City:MACEDON
Mailing Address - State:NY
Mailing Address - Zip Code:14502-9208
Mailing Address - Country:US
Mailing Address - Phone:646-533-2724
Mailing Address - Fax:
Practice Address - Street 1:225 PLUMEGRASS RUN
Practice Address - Street 2:
Practice Address - City:MACEDON
Practice Address - State:NY
Practice Address - Zip Code:14502-9208
Practice Address - Country:US
Practice Address - Phone:646-533-2724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343111-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse