Provider Demographics
NPI:1447253828
Name:HALL, ERIN MICHELLE (PAC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MICHELLE
Last Name:HALL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36000 DARNALL LOOP
Mailing Address - Street 2:CARL R DARNALL ARMY MEDICAL CENTER
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:254-285-6230
Mailing Address - Fax:
Practice Address - Street 1:36000 DARNALL LOOP
Practice Address - Street 2:CARL R DARNALL AMC
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-288-8000
Practice Address - Fax:254-286-7326
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2011-06-13
Deactivation Date:2005-06-02
Deactivation Code:
Reactivation Date:2006-07-25
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00116200363A00000X
PAMA051603363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223596388OtherTAX IDENTIFICATION #
NJQ21433Medicare UPIN
NJ223596388OtherTAX IDENTIFICATION #