Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 21470 | SC |
NPI | 1023520715 |
---|---|
Provider Name | Andrea R Hall |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-2008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2017 |
Last Update Date | 25/11/2020 |