Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1154813434 |
---|---|
Provider Name | Kylene Hall |
First Address | Detroit, MI 48235-2318 |
Second Address | Detroit, MI 48235-2318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2018 |
Last Update Date | 03/06/2018 |