Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 9658742 | LA |
NPI | 1295714624 |
---|---|
Provider Name | Mrs. Johnetta Renee Hall |
First Address | New Iberia, LA 70562-0844 |
Second Address | New Iberia, LA 70560-5676 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 08/07/2007 |