Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 734 | NC |
N | 213ES0103X | Foot & Ankle Surgery | 734 | NC |
N | 213ES0131X | Foot Surgery | 734 | NC |
NPI | 1609368117 |
---|---|
Provider Name | Shalanda Latrice Hall |
First Address | Concord, NC 28025-2911 |
Second Address | Matthews, NC 28105-6722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2018 |
Last Update Date | 15/12/2021 |