Individual
MARY JANE HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
971 11TH AVE, LONGVIEW, WA 98632-2503
(360) 577-1771
(360) 423-1405
Mailing address
971 11TH AVE, LONGVIEW, WA 98632-2503
(360) 577-1771
(360) 423-1405
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
AP30001925
WA
208000000X
Pediatrics Physician
RN00097178
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9605767
—
WA
Enumeration date
06/05/2006
Last updated
04/26/2012
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