Provider Demographics
NPI:1124221817
Name:HALL, LAURA (PA)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-0589
Mailing Address - Country:US
Mailing Address - Phone:919-497-3523
Mailing Address - Fax:919-562-3052
Practice Address - Street 1:3386 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:NC
Practice Address - Zip Code:27525
Practice Address - Country:US
Practice Address - Phone:919-494-9949
Practice Address - Fax:919-494-2360
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101203363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC101203OtherLICENSE NO.