Healthcare Provider Details

I. General information

NPI: 1659797249
Provider Name (Legal Business Name): WENDY MICHELE HALL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WENDY MICHELE BOOHER APRN

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 CALDER ST
BEAUMONT TX
77702-1809
US

IV. Provider business mailing address

2830 CALDER STREET
BEAUMONT TX
77706
US

V. Phone/Fax

Practice location:
  • Phone: 409-899-7000
  • Fax:
Mailing address:
  • Phone: 409-899-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number776697
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: