Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 2013010740 | MO |
N | 207P00000X | Emergency Physician | OS016490 | PA |
NPI | 1003103193 |
---|---|
Provider Name | Dr. Beth Ann Hakala |
First Address | Clinton, MO 64735-1192 |
Second Address | Clinton, MO 64735-1192 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2011 |
Last Update Date | 16/07/2015 |