Healthcare Provider Details

I. General information

NPI: 1831396985
Provider Name (Legal Business Name): MICHELLE D HALL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 S VAN BUREN RD STE F
EDEN NC
27288-5300
US

IV. Provider business mailing address

824 S VAN BUREN RD STE F
EDEN NC
27288-5300
US

V. Phone/Fax

Practice location:
  • Phone: 336-589-6399
  • Fax:
Mailing address:
  • Phone: 336-589-6399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201926
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024166710
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: