Provider Demographics
NPI:1689132201
Name:HALLMAN, EDWINA MARIE
Entity type:Individual
Prefix:
First Name:EDWINA
Middle Name:MARIE
Last Name:HALLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 SPRING LN
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:SC
Mailing Address - Zip Code:29127-6307
Mailing Address - Country:US
Mailing Address - Phone:619-944-5206
Mailing Address - Fax:
Practice Address - Street 1:32 RIVER ST
Practice Address - Street 2:
Practice Address - City:PEAK
Practice Address - State:SC
Practice Address - Zip Code:29122
Practice Address - Country:US
Practice Address - Phone:803-945-7475
Practice Address - Fax:803-945-0000
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22678363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily