Basic Information
Provider Information
NPI: 1003138942
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HALL
FirstName: THOMAS
MiddleName: RYAN
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 31000-0698
Address2:  
City: PASADENA
State: CA
PostalCode: 911100698
CountryCode: US
TelephoneNumber: 6022631200
FaxNumber: 6022631631
Practice Location
Address1: 4212 N 16TH ST
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850165319
CountryCode: US
TelephoneNumber: 6022631200
FaxNumber: 6022631631
Other Information
ProviderEnumerationDate: 02/19/2010
LastUpdateDate: 02/19/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X685677TXY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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