Provider Demographics
NPI:1396086427
Name:HALL, MICHELLE ERIN
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ERIN
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:E
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:705 E RANDALL ST
Mailing Address - Street 2:
Mailing Address - City:HESSTON
Mailing Address - State:KS
Mailing Address - Zip Code:67062-8806
Mailing Address - Country:US
Mailing Address - Phone:620-327-2440
Mailing Address - Fax:620-627-2062
Practice Address - Street 1:705 E RANDALL ST
Practice Address - Street 2:
Practice Address - City:HESSTON
Practice Address - State:KS
Practice Address - Zip Code:67062-8806
Practice Address - Country:US
Practice Address - Phone:620-327-2440
Practice Address - Fax:620-627-2062
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS75784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily