Individual
RENE HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MLT
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
37789
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0140070
—
SD
01
—
5549050
MEDICAID
SD
Enumeration date
12/20/2016
Last updated
12/20/2016
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