Provider Demographics
NPI:1992144489
Name:HALL, VIRGINIA DENISE (CNP)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:DENISE
Last Name:HALL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6552 AGNES AVE # 4319
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1517
Mailing Address - Country:US
Mailing Address - Phone:419-834-3441
Mailing Address - Fax:
Practice Address - Street 1:1201 S VICTORY BLVD STE 206
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2793
Practice Address - Country:US
Practice Address - Phone:747-271-2701
Practice Address - Fax:310-693-5384
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010976363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0086457Medicaid