Healthcare Provider Details

I. General information

NPI: 1497175418
Provider Name (Legal Business Name): MARK HULL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 N MEADOW LAKES LOOP
WASILLA AK
99623
US

IV. Provider business mailing address

PO BOX 872076
WASILLA AK
99687-2076
US

V. Phone/Fax

Practice location:
  • Phone: 907-841-7686
  • Fax: 907-373-5356
Mailing address:
  • Phone: 907-841-7686
  • Fax: 907-373-5356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number909120
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: