Basic Information
Provider Information
NPI: 1164549150
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HALL
FirstName: MARGUERITE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: R.N.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1522 E A ST
Address2:  
City: CASPER
State: WY
PostalCode: 826012217
CountryCode: US
TelephoneNumber: 3072336000
FaxNumber: 3072336088
Practice Location
Address1: 1522 E A ST
Address2:  
City: CASPER
State: WY
PostalCode: 826012217
CountryCode: US
TelephoneNumber: 3072336000
FaxNumber: 3072336088
Other Information
ProviderEnumerationDate: 03/23/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WG0000X18222WYY Nursing Service ProvidersRegistered NurseGeneral Practice

No ID Information.


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