Provider Demographics
NPI:1871904276
Name:HALL, FAWN
Entity type:Individual
Prefix:
First Name:FAWN
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 CANYON RD SE
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:OH
Mailing Address - Zip Code:43025-9694
Mailing Address - Country:US
Mailing Address - Phone:740-504-0611
Mailing Address - Fax:740-928-1044
Practice Address - Street 1:8210 LANCASTER NEWARK RD NE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:OH
Practice Address - Zip Code:43105-9543
Practice Address - Country:US
Practice Address - Phone:740-504-0611
Practice Address - Fax:740-928-1044
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000182171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist