Provider Demographics
NPI:1255936035
Name:HALL, CHARLES EDWARD (LPN)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:HALL
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25611 98TH AVE S APT G306
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6396
Mailing Address - Country:US
Mailing Address - Phone:408-772-7327
Mailing Address - Fax:
Practice Address - Street 1:25611 98TH AVE S APT G306
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6396
Practice Address - Country:US
Practice Address - Phone:408-772-7327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP.61123714164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse