Provider Demographics
NPI:1053756585
Name:HALL, ANNIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3661 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 64
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3003
Mailing Address - Country:US
Mailing Address - Phone:702-735-7900
Mailing Address - Fax:702-735-0081
Practice Address - Street 1:3661 S MARYLAND PKWY
Practice Address - Street 2:SUITE 64
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3003
Practice Address - Country:US
Practice Address - Phone:702-735-7900
Practice Address - Fax:702-735-0081
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLPN02933164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse