Healthcare Provider Details

I. General information

NPI: 1043756265
Provider Name (Legal Business Name): MONICA M HALL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 LAUREL STREET
BEAUMONT TX
77707
US

IV. Provider business mailing address

3650 LAUREL STREET
BEAUMONT TX
77707
US

V. Phone/Fax

Practice location:
  • Phone: 409-838-0346
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP133071
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: