Individual
MARY CLAIRE HALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1520 S LIBERTY DR, BLOOMINGTON, IN 47403-5167
(812) 676-4300
Mailing address
947 KIRKWOOD DR, EVANSVILLE, IN 47715-4564
(812) 499-7051
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10004527A
IN
363A00000X
Physician Assistant
10004527B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104718375
ANTHEM PTAN
IN
Enumeration date
09/10/2024
Last updated
01/21/2025
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