Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 170100000X | Medical Geneticist | 36463 | NC |
Y | 207Q00000X | Family Doctor | 22874 | NC |
NPI | 1811991342 |
---|---|
Provider Name | Myra Jane Hall |
First Address | Aberdeen, NC 28315-2226 |
Second Address | Aberdeen, NC 28315-2226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 04/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8911477 | (05) | NC |
G18022 | (02) | |
G18022 | (02) | NC |