Healthcare Provider Details

I. General information

NPI: 1437494788
Provider Name (Legal Business Name): AMANDA JUDEIKA HULSING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 E SEMINOLE DR
PHOENIX AZ
85022-6402
US

IV. Provider business mailing address

1048 E SEMINOLE DR
PHOENIX AZ
85022-6402
US

V. Phone/Fax

Practice location:
  • Phone: 480-776-9285
  • Fax:
Mailing address:
  • Phone: 480-776-9285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN175377
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: