Healthcare Provider Details

I. General information

NPI: 1457794539
Provider Name (Legal Business Name): MS. EARLIE HALE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W 10TH ST
INDIANAPOLIS IN
46202-2803
US

IV. Provider business mailing address

3336 HIGHWOODS DR N
INDIANAPOLIS IN
46222-1824
US

V. Phone/Fax

Practice location:
  • Phone: 317-988-3934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number28150024A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: