| NPI | 1689186124 |
|---|---|
| Former Name | JEANETTE ELLA HALL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 305S00000X Point of Service (Licence: FL W445166) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: FL W445166) |
| 302R00000X Health Maintenance Organization (Licence: FL W445166) | |
| 305R00000X Preferred Provider Organization (Licence: FL W445166) | |
| Enumeration Date | 2017-10-24 |
| Last Update Date | 2017-10-24 |