Basic Information
| Provider Information | |||||||||
| NPI: | 1194703975 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 502 3RD ST | ||||||||
| Address2: | |||||||||
| City: | PARKERSBURG | ||||||||
| State: | IA | ||||||||
| PostalCode: | 506652063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193462331 | ||||||||
| FaxNumber: | 3193461531 | ||||||||
| Practice Location | |||||||||
| Address1: | 502 3RD ST | ||||||||
| Address2: | |||||||||
| City: | PARKERSBURG | ||||||||
| State: | IA | ||||||||
| PostalCode: | 506652063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193462331 | ||||||||
| FaxNumber: | 3193461531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2006 | ||||||||
| LastUpdateDate: | 10/22/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 076662 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 2419168 | 05 | IA | MEDICAID | 0419168 | 05 | IA | MEDICAID | 3419168 | 05 | IA | MEDICAID |