=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548580806
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUANNE YANG HALE MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2010
-----------------------------------------------------
Last Update Date | 12/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5018 DR PHILLIPS BLVD NEMOURS CHILDRENS URGENT CARE, WINDERMERE
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32819-3310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-363-5753
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 191 PROVIDER ENROLLMENT DEPT
-----------------------------------------------------
City | ROCKLAND
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19732-0191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-651-6212
-----------------------------------------------------
Fax | 302-651-4945
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME124105
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | 0116022415
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 0101253861
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------