Provider Demographics
NPI:1881052090
Name:HALL, BRITTANY MONAE (CNM)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:MONAE
Last Name:HALL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4258
Mailing Address - Country:US
Mailing Address - Phone:803-774-6448
Mailing Address - Fax:803-774-8299
Practice Address - Street 1:319 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4258
Practice Address - Country:US
Practice Address - Phone:803-774-6448
Practice Address - Fax:803-774-8299
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19982367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCFQC048OtherMEDICAID
SC7124OtherMEDICARE