Healthcare Provider Details

I. General information

NPI: 1821380585
Provider Name (Legal Business Name): HARVEY FRANK HULSE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC BAVARIA CMR 411 BLDG 700 ROSE BARRACKS
APO AE
09112
US

IV. Provider business mailing address

225 SAGUARO DR
GALLUP NM
87301-6768
US

V. Phone/Fax

Practice location:
  • Phone: 499662834719
  • Fax: 499662834721
Mailing address:
  • Phone: 505-722-3336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number108780
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: