Provider Demographics
NPI:1447253828
Name:HALL, ERIN MICHELLE (PAC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MICHELLE
Last Name:HALL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 ROCK MERRITT AVE
Mailing Address - Street 2:WOMACK ARMY MEDICAL CENTER
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-907-8922
Mailing Address - Fax:910-907-6069
Practice Address - Street 1:2817 ROCK MERRITT AVE
Practice Address - Street 2:WOMACK ARMY MEDICAL CENTER
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-8922
Practice Address - Fax:910-907-6069
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2025-11-05
Deactivation Date:2005-06-02
Deactivation Code:
Reactivation Date:2006-07-25
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00116200363A00000X
PAMA051603363A00000X
NC00010-02000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223596388OtherTAX IDENTIFICATION #
NJQ21433Medicare UPIN
NJ223596388OtherTAX IDENTIFICATION #