Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 2020131277 | IN |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 71011860A | IN |
NPI | 1285202440 |
---|---|
Provider Name | Mrs. Whitney Hall |
First Address | Pekin, IN 47165-8743 |
Second Address | Pekin, IN 47165-8743 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2021 |
Last Update Date | 15/12/2021 |