Provider Demographics
NPI:1427826213
Name:MAYNOR, HALLIE MIKALA
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:MIKALA
Last Name:MAYNOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8797 NC HIGHWAY 72
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-8033
Mailing Address - Country:US
Mailing Address - Phone:910-740-4143
Mailing Address - Fax:
Practice Address - Street 1:8797 NC HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-8033
Practice Address - Country:US
Practice Address - Phone:910-740-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program