Provider Demographics
NPI:1861607236
Name:HALL, TAMARA LYNN (LPN)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:LYNN
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 1:1145 TWP RD 1293
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-0000
Mailing Address - Country:US
Mailing Address - Phone:419-651-1949
Mailing Address - Fax:
Practice Address - Street 1:1145 TWP RD 1293
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-0000
Practice Address - Country:US
Practice Address - Phone:419-651-1949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103689164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2555015Medicaid