Provider Demographics
NPI:1760505416
Name:HALL, BRYAN DOYLE (RN)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:DOYLE
Last Name:HALL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 CAYUGA ST
Mailing Address - Street 2:APT 8
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1638
Mailing Address - Country:US
Mailing Address - Phone:716-474-6465
Mailing Address - Fax:
Practice Address - Street 1:89 B RIVER RD
Practice Address - Street 2:THE DALE ASSOCIATION
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120
Practice Address - Country:US
Practice Address - Phone:716-693-9961
Practice Address - Fax:716-693-4402
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY504734163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health