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Individual

MR. SHANNON D DALE HALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
500 COLLEGE ST, YALE NEW HAVEN HOSPITAL, NEW HAVEN, CT 06511-8962
(203) 432-2700
Mailing address
640 URLACHER DR, MURFREESBORO, TN 37129-8998
(615) 796-0057

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
003790
CT
367500000X
Certified Registered Nurse Anesthetist
071173
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
20635
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3634996
TN
01
4072296
BCBS NUMBER
TN
05
74007634
KY
05
PENDING
SC
Enumeration date
07/29/2005
Last updated
12/21/2021
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