Healthcare Provider Details

I. General information

NPI: 1043355282
Provider Name (Legal Business Name): ERIKA JAN HALL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 MAIN STREET
N. VASSALBORO ME
04962
US

IV. Provider business mailing address

80 GARLAND RD
WINSLOW ME
04901-0600
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-6173
  • Fax: 207-873-4514
Mailing address:
  • Phone: 207-873-1098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-463
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: