Provider Demographics
NPI:1043355282
Name:HALL, ERIKA JAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ERIKA
Middle Name:JAN
Last Name:HALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 GARLAND RD
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:ME
Mailing Address - Zip Code:04901-0600
Mailing Address - Country:US
Mailing Address - Phone:207-873-1098
Mailing Address - Fax:
Practice Address - Street 1:905 MAIN STREET
Practice Address - Street 2:
Practice Address - City:N. VASSALBORO
Practice Address - State:ME
Practice Address - Zip Code:04962
Practice Address - Country:US
Practice Address - Phone:207-873-6173
Practice Address - Fax:207-873-4514
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-463363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant