Healthcare Provider Details

I. General information

NPI: 1558197590
Provider Name (Legal Business Name): ERIKA MAREN HULSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 W 9TH PL S
MESA AZ
85201-4258
US

IV. Provider business mailing address

319 W 9TH PL S
MESA AZ
85201-4258
US

V. Phone/Fax

Practice location:
  • Phone: 801-541-8014
  • Fax:
Mailing address:
  • Phone: 801-541-8014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number12615458-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: