Provider Demographics
NPI:1295714624
Name:HALL, JOHNETTA RENEE (MEDICAL ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:JOHNETTA
Middle Name:RENEE
Last Name:HALL
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
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Mailing Address - Street 1:PO BOX 10844
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70562-0844
Mailing Address - Country:US
Mailing Address - Phone:337-256-5732
Mailing Address - Fax:337-256-5732
Practice Address - Street 1:915 ANN ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-5676
Practice Address - Country:US
Practice Address - Phone:337-256-5732
Practice Address - Fax:337-256-5732
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA9658742170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics