Provider Demographics
NPI:1649896168
Name:HALL, DASHIA N
Entity type:Individual
Prefix:
First Name:DASHIA
Middle Name:N
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 1:3826 WINSTON AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41015-1458
Mailing Address - Country:US
Mailing Address - Phone:859-415-0405
Mailing Address - Fax:
Practice Address - Street 1:3826 WINSTON AVE STE 300
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41015-1458
Practice Address - Country:US
Practice Address - Phone:859-415-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-20
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH844671729Medicaid
OH84-4671729Medicaid